scholarly journals Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charle André Viljoen ◽  
Rob Scott Millar ◽  
Kathryn Manning ◽  
Julian Hoevelmann ◽  
Vanessa Celeste Burch
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Training ◽  
Case Vignette ◽  
Clinical Context ◽  
Clinical Exposure ◽  
Case Vignettes ◽  
The Impact ◽  
Senior Students ◽  
Junior Students ◽  
Ecg Interpretation

Abstract Background ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation. We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis. Methods Fourth- (junior) and sixth-year (senior) medical students, as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately thereafter, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested. Eligible participants completed both tests and survey. We estimated that a minimum sample size of 165 participants would provide 80% power to detect a mean difference of 7% in test scores, considering a type 1 error of 5%. Results This study comprised 176 participants (67 [38.1%] junior students, 55 [31.3%] senior students, 54 [30.7%] residents). Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, there was a marginal improvement in ECG diagnostic accuracy when the clinical context was known (Cohen’s d = 0.35, p < 0.001). Gains in diagnostic accuracy were more pronounced amongst residents (Cohen’s d = 0.59, p < 0.001), than senior (Cohen’s d = 0.38, p < 0.001) or junior students (Cohen’s d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24–1.71) or not (OR 1.58, 95% CI 1.35–1.84). Conclusion ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior clinical exposure. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone, but instead be supplemented by other formal methods of instruction.

scholarly journals Clinically contextualised ECG interpretation

2021 ◽  
Author(s):  
Charle André Viljoen ◽  
Rob Scott Millar ◽  
Kathryn Manning ◽  
Julian Hoevelmann ◽  
Vanessa Celeste Burch
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Training ◽  
Medical Residents ◽  
Case Vignette ◽  
Clinical Context ◽  
Real Patient ◽  
Case Vignettes ◽  
Senior Students ◽  
Junior Students ◽  
Ecg Interpretation

Abstract Background ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation.Methods We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis. Fourth- (junior) and sixth-year (senior) medical students as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey on the same day. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately after Test 1, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested in Test 1 and 2.Results This study comprised 176 participants, of which 67 (38.1%) were junior students, 55 (31.3%) were senior students and 54 (30.7%) were medical residents. Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, all groups showed a marginal improvement in accuracy of ECG interpretation when the clinical context was known to them (Cohen’s d = 0.35, p < 0.001). The gains in accuracy were more pronounced amongst residents (Cohen’s d = 0.59, p < 0.001), than amongst senior (Cohen’s d = 0.38, p < 0.001) or junior students (Cohen’s d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24–1.71) or not (OR 1.58, 95% CI 1.35–1.84).Conclusion ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior exposure during clinical training. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone for teaching electrocardiography, but instead be supplemented by other formal methods of instruction.

scholarly journals Web-based Medical Education During COVID-19 Lockdown: A Step Back or a Leap to the Future?

2021 ◽  
pp. 153473462110118
Author(s):  
Anna Eleftheriou ◽  
Aikaterini Rokou ◽  
Christos Argyriou ◽  
Nikolaos Papanas ◽  
George S. Georgiadis
Keyword(s):  
Medical Education ◽  
Clinical Training ◽  
Medical Training ◽  
Medical Schools ◽  
Web Based ◽  
Clinical Exposure ◽  
Virtual Teaching ◽  
Based Medicine ◽  
The Impact

The impact of coronavirus infectious disease (COVID-19) on medical education has been substantial. Medical students require considerable clinical exposure. However, due to the risk of COVID-19, the majority of medical schools globally have discontinued their normal activities. The strengths of virtual teaching now include a variety of web-based resources. New interactive forms of virtual teaching are being developed to enable students to interact with patients from their homes. Conversely, students have received decreased clinical training in certain medical and surgical specialities, which may, in turn, reduce their performance, confidence, and abilities as future physicians. We sought to analyze the effect of telemedicine on the quality of medical education in this new emerging era and highlight the benefits and drawbacks of web-based medical training in building up future physicians. The COVID-19 pandemic has posed an unparalleled challenge to medical schools, which are aiming to deliver quality education to students virtually, balancing between evidence-based and experience-based medicine.

scholarly journals Impact of the COVID-19 Pandemic on Breast Imaging Education

2021 ◽  
Author(s):  
James S Chalfant ◽  
Sarah M Pittman ◽  
Pranay D Kothari ◽  
Alice Chong ◽  
Lars J Grimm ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Clinical Training ◽  
Negative Impact ◽  
Career Decisions ◽  
General Linear Model ◽  
Patient Contact ◽  
Structured Education ◽  
Clinical Exposure ◽  
The Impact ◽  
Future Plans

Abstract Objective To determine the impact of the COVID-19 pandemic on breast imaging education. Methods A 22-item survey addressing four themes during the early pandemic (time on service, structured education, clinical training, future plans) was emailed to Society of Breast Imaging members and members-in-training in July 2020. Responses were compared using McNemar’s and Mann-Whitney U tests; a general linear model was used for multivariate analysis. Results Of 136 responses (136/2824, 4.8%), 96 U.S. responses from radiologists with trainees, residents, and fellows were included. Clinical exposure declined during the early pandemic, with almost no medical students on service (66/67, 99%) and fewer clinical days for residents (78/89, 88%) and fellows (48/68, 71%). Conferences shifted to remote live format (57/78, 73%), with some canceled (15/78, 19%). Compared to pre-pandemic, resident diagnostic (75/78, 96% versus 26/78, 33%) (P&lt;0.001) and procedural (73/78, 94% versus 21/78, 27%) (P&lt;0.001) participation fell, as did fellow diagnostic (60/61, 98% versus 47/61, 77%) (P=0.001) and procedural (60/61, 98% versus 43/61, 70%) (P&lt;0.001) participation. Most thought that the pandemic negatively influenced resident and fellow screening (64/77, 83% and 43/60, 72%, respectively), diagnostic (66/77, 86% and 37/60, 62%), and procedural (71/77, 92% and 37/61, 61%) education. However, a majority thought that decreased time on service (36/67, 54%) and patient contact (46/79, 58%) would not change residents’ pursuit of a breast imaging fellowship. Conclusion The pandemic has had a largely negative impact on breast imaging education, with reduction in exposure to all aspects of breast imaging. However, this may not affect career decisions.

scholarly journals Does anthropomorphic model design in ex vivo studies affect diagnostic accuracy for dental root fracture using CBCT?

2020 ◽  
Vol 49 (7) ◽  
pp. 20200093
Author(s):  
Fedil Andraws Yalda ◽  
Rosalyn J Clarkson ◽  
Jonathan Davies ◽  
Peter G J Rout ◽  
Anita Sengupta ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Ex Vivo ◽  
Model Design ◽  
Fracture Detection ◽  
Root Fracture ◽  
Clinical Exposure ◽  
Published Evidence ◽  
Dental Applications ◽  
The Impact ◽  
Confidence Scale

Objectives: The evidence for diagnostic accuracy using cone beam computed tomography (CBCT) for dental applications depends heavily on ex vivo research, but there is little knowledge of whether the model used affects the diagnostic accuracy results. The objective of this study was to determine the impact of different designs of anthropomorphic models on diagnostic accuracy for the specific task of dental root fracture detection. Methods: Horizontal or oblique root fracture was induced in 24 of 48 permanent maxillary incisors. The 48 teeth were scanned by CBCT using standard clinical exposure factors on five occasions, each with a different model design. Scans were viewed by five dental and maxillofacial radiologists, who each made a forced diagnosis of fracture or no fracture in each root and a judgment on root fracture using a five-point confidence scale. Sensitivity (Se), specificity (Sp) and areas under receiver operating characteristic (ROC) curve (Az) were calculated for each observer for each model. Results: There were no significant differences between the diagnostic accuracy measurements recorded using different models. There were, however, numerous significant differences between observers using the same anthropomorphic model. Conclusions: Despite the differences in X-ray attenuation between the five model designs, the results suggest that the anthropomorphic model does not affect the results of diagnostic accuracy studies on root fracture using this CBCT machine at standard clinical exposures. This provides some confidence in the previously published evidence. The interobserver diagnosis differences indicate that research using only two observers could provide misleading results.

scholarly journals Prevalence and significance of T-wave inversion in Arab and Black paediatric athletes: Should anterior T-wave inversion interpretation be governed by biological or chronological age?

2018 ◽  
Vol 26 (6) ◽  
pp. 641-652 ◽  
Author(s):  
Gavin McClean ◽  
Nathan R Riding ◽  
Guido Pieles ◽  
Sanjay Sharma ◽  
Victoria Watt ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Biological Age ◽  
Chronological Age ◽  
Clinical Context ◽  
T Wave ◽  
Wave Inversion ◽  
Ecg Interpretation

Background International electrocardiographic (ECG) recommendations regard anterior T-wave inversion (ATWI) in athletes under 16 years to be normal. Design The aim of this study was to identify the prevalence, distribution and determinants of TWI by ethnicity, chronological and biological age within paediatric athletes. A second aim was to establish the diagnostic accuracy of international ECG recommendations against refinement within athletes who present with ECG variants isolated to ATWI (V1–V4) using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis. Methods Four hundred and eighteen Arab and 314 black male athletes (11–18 years) were evaluated by ECG, echocardiogram and biological age (by radiological X-ray) assessment. Results A total of 116 (15.8%) athletes presented with ATWI (V1–V4), of which 96 (82.8%) were observed in the absence of other ECG findings considered to be abnormal as per international recommendations for ECG interpretation in athletes; 91 (12.4%) athletes presented with ATWI confined to V1–V3, with prevalence predicted by black ethnicity (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.3–3.5) and biological age under 16 years (OR 2.0, 95% CI 1.2–3.3). Of the 96 with ATWI (V1–V4) observed in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes, diagnostic accuracy was ‘fail’ (OR 0.47, 95% CI 0.00–1.00) for international recommendations and ‘excellent’ (OR 0.97, 95% CI 0.92–1.00) when governed by biological age under 16 years, providing a positive and negative likelihood ratio of 15.8 (95% CI 1.8–28.1) and 0.0 (95% CI 0.0–0.8), respectively. Conclusion Interpretation of ECG variants isolated with ATWI (V1–V4) using international recommendations (chronological age <16 years) warrants caution, but governance by biological age yielded an ‘excellent’ diagnostic accuracy. In the clinical context, the ‘chance’ of detecting cardiac pathology within a paediatric male athlete presenting with ATWI in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes (positive likelihood ratio 15.8), was 14.4%, whereas a negative ECG (negative likelihood ratio 0.0) was 0%.

An experimental investigation on the perception of depression among the public

2011 ◽  
Vol 26 (S2) ◽  
pp. 685-685
Author(s):  
M. Schmoeger ◽  
A. Schosser ◽  
S. Jantscher ◽  
E. Auff ◽  
U. Willinger
Keyword(s):  
Mental Disorders ◽  
Case Vignette ◽  
Psychiatric Research ◽  
The Public ◽  
Lay Beliefs ◽  
Mental Health Settings ◽  
Case Vignettes ◽  
Main Effects ◽  
The Impact ◽  
Depressive Patients

Studies on beliefs regarding mental disorders take an interest in the question what beliefs about the causes are prevalent among the public. Studies using case vignettes concluded that lay beliefs about the causes of mental disorders clearly differ from the results of psychiatric research in view of the fact psychosocial factors are predominating in comparison with biological factors (Angermeyer & Dietrich, 2006). The aim of the present study is the evaluation of the impact of causal labels (biological/genetic, psychological/environmental or cause unknown), sex of the person described in a case vignette and sex of the participants on the perception of depression. The sample consists of 312 non-clinical participants (47.10% men, 52.90% women; mean age ± SD: 29.17 ± 12.76) who are not involved in mental health settings. To identify participants’ attitude towards depressive patients the experimental design of Lam et al. (2005) was modified and adjusted. A three way ANOVA was conducted to examine effects of causal labels, type of case vignette and sex of the participants on the attitude towards depressed patients. Simple main effects analysis only showed a significant main effect concerning sex of the participants (F = 5, 148, df = 1, p = 0,024).The results of the current study suggest that in comparison to men, women believe that depressive patients are more affected by the symptoms of the disorder. Neither the information about the aetiology of the disorder, nor sex of the person described in the case vignette seems to have an impact on the beliefs of the participants.

Reducing the Social Stigma Associated with Obsessive Compulsive Disorder: A Controlled Trial of an Intervention Program in a Turkish Community Sample

2020 ◽  
Vol 20 (2) ◽  
pp. 101-120
Author(s):  
Ayça Aktaç Gürbüz ◽  
Orçun YORULMAZ ◽  
Gülşah DURNA
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Intervention Program ◽  
Controlled Trial ◽  
Community Sample ◽  
Case Vignette ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
The Impact

Scientific research into the reduction of stigmatization, particularly related to specific problems such as Obsessive-Compulsive Disorder (OCD), is scarce. In the present study, we examine the impact of a video-based antistigma intervention program for OCD in a pretest-posttest control group research. After being randomly assigned to either an intervention (n= 101) or control group (n= 96), the participants reported their attitudes on a hypothetical case vignette before and after OCD vs. Multiple Sclerosis (MS) videos, and again six months later as a follow up assessment. The mixed design analyses for the group comparisons indicated that although there was no significant difference in the measures of the control group, the participants watching the anti-stigma OCD video, in which the focus was psychoeducation and interaction strategies, reported significantly lower scores on social distances and negative beliefs for the case vignettes they read, and this difference was maintained six months later. Then, the present results indicate the effectiveness of our anti-stigma intervention program for OCD. Interventions to reduce stigmatization can also be viewed as effective tools for changing the attitudes of people toward OCD, although further research and applications are needed related to specific disorders if a longlasting impact is to be achieved.

45. Education at distance: Broadcasting ECG rounds to Southeastern Ontario (BESO Project). An innovative approach for teaching electrocardiography

2007 ◽  
Vol 30 (4) ◽  
pp. 51 ◽  
Author(s):  
A. Baranchuk ◽  
G. Dagnone ◽  
P. Fowler ◽  
M. N. Harrison ◽  
L. Lisnevskaia ◽  
...  
Keyword(s):  
Health Care ◽  
Real Time ◽  
Digital Signal ◽  
Teaching Methodology ◽  
Care Providers ◽  
Long Distance ◽  
Medicine Clerkship ◽  
Time Problem ◽  
The Impact ◽  
Ecg Interpretation

Electrocardiography (ECG) interpretation is an essential skill for physicians as well as for many other health care professionals. Continuing education is necessary to maintain these skills. The process of teaching and learning ECG interpretation is complex and involves both deductive mechanisms and recognition of patterns for different clinical situations (“pattern recognition”). The successful methodologies of interactive sessions and real time problem based learning have never been evaluated with a long distance education model. To evaluate the efficacy of broadcasting ECG rounds to different hospitals in the Southeastern Ontario region; to perform qualitative research to determine the impact of this methodology in developing and maintaining skills in ECG interpretation. ECG rounds are held weekly at Kingston General Hospital and will be transmitted live to Napanee, Belleville, Oshawa, Peterborough and Brockville. The teaching methodology is based on real ECG cases. The audience is invited to analyze the ECG case and the coordinator will introduce comments to guide the case through the proper algorithm. Final interpretation will be achieved emphasizing the deductive process and the relevance of each case. An evaluation will be filled out by each participant at the end of each session. Videoconferencing works through a vast array of internet LANs, WANs, ISDN phone lines, routers, switches, firewalls and Codecs (Coder/Decoder) and bridges. A videoconference Codec takes the analog audio and video signal codes and compresses it into a digital signal and transmits that digital signal to another Codec where the signal is decompressed and retranslated back into analog video and audio. This compression and decompression allows large amounts of data to be transferred across a network at close to real time (384 kbps with 30 frames of video per second). Videoconferencing communication works on voice activation so whichever site is speaking has the floor and is seen by all the participating sites. A continuous presence mode allows each site to have the same visual and audio involvement as the host site. A bridged multipoint can connect between 8 and 12 sites simultaneously. This innovative methodology for teaching ECG will facilitate access to developing and maintaining skills in ECG interpretation for a large number of health care providers. Bertsch TF, Callas PW, Rubin A. Effectiveness of lectures attended via interactive video conferencing versus in-person in preparing third-year internal medicine clerkship students for clinical practice examinations. Teach Learn Med 2007; 19(1):4-8. Yellowlees PM, Hogarth M, Hilty DM. The importance of distributed broadband networks to academic biomedical research and education programs. Acad Psychaitry 2006;30:451-455

scholarly journals The Fellow’s Perspective: The Impact of the COVID-19 Pandemic on Fellowship Training and Job Appointment

2021 ◽  
pp. 000313482110241
Author(s):  
Adam Truong ◽  
Farin Amersi ◽  
Van Chau ◽  
Taryne Imai
Keyword(s):  
Clinical Training ◽  
Medical Center ◽  
Fellowship Training ◽  
Surgical Specialty ◽  
Job Interview ◽  
Educational Structure ◽  
Global Pandemic ◽  
Procedural Volume ◽  
Interview Format ◽  
The Impact

Background Fellows have been uniquely affected by the widespread changes in educational structure, mandatory limitations in elective procedural volume, and hiring freezes during the COVID-19 global pandemic. Study Design A voluntary and anonymous survey was distributed to all Graduate Medical Education fellows at a tertiary medical center querying perspectives on clinical and didactic training and job placement. Results A total of 47 of 121 fellows (39%) completed the survey. The majority were in a medical (43%) or surgical specialty (34%) followed by critical care (13%) and procedure-based (11%) fellowships. Approximately 59% of surveyed fellows felt their programs were providing a virtual curriculum that would train them just as well as the in-person curriculum. Twenty-eight (60%) fellows were in their final or only year of training. Of the 25 fellows who were seeking employment, 52% have experienced difficulty in finding a job due to hiring freezes and 40% have encountered challenges with job interview cancellations and changes to virtual interview formats. Conclusion Almost half of surveyed fellows reported an educational deterioration due to COVID-19 and graduating fellows seeking employment felt hindered by both the virtual interview format and widespread hiring freeze. Fellows are both unique and vulnerable as they balance the solidification of clinical training with securing employment during these tumultuous and unprecedented times.

scholarly journals Evaluating the Impact of Training Health Professionals to Deliver Brief Motivational and Skills-Based Interventions for Cannabis Use Disorder

2012 ◽  
Vol 2 ◽  
Author(s):  
Dion Alperstein ◽  
Jan Copeland
Keyword(s):  
Clinical Training ◽  
Health Workers ◽  
Clinical Skills ◽  
Cannabis Use ◽  
Evidence Based ◽  
Transfer Of Knowledge ◽  
Evidence Based Treatment ◽  
Cognitive Behavioural ◽  
The Impact

Background: While there is considerable evidence that brief motivational and skills-based interventions for substance use are effective, little is known regarding the transfer of knowledge from research to practice. This study aims to evaluate the effectiveness of two half-day didactic clinical training workshops for allied health workers, which did not incorporate feedback or supervision, via independent follow-up three months post training.Methods: In total, 1322 participants attended either or both of the evidence-based treatment workshops run by the National Cannabis Prevention and Information Centre. Of those participants, 495 (37%) completed an online follow-up evaluation three months later regarding their use of the newly learnt intervention(s).Results: At follow-up, 270 (54.5%) participants had an opportunity to use the skills and 144 (53.3%) of those participants reported having used the clinical skills taught in the workshop. Of those who used one of the interventions, 90 (62.5%) participants reported their clients had reduced or quit their cannabis use. Furthermore, 43 (30%) of these participants had attempted to train others in the workplace in the techniques learnt in the workshop.Conclusion: Even a half-day didactic clinical training workshop on evidence-based brief cognitive–behavioural techniques delivered to clinicians working in the field can improve knowledge and confidence among clinicians and outcomes among their clients with cannabis use related problems.

Sign in / Sign up

Export Citation Format

Share Document