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 ◽  
...  

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.

2021 ◽  
pp. 019459982198960
Author(s):  
Tiffany V. Wang ◽  
Nat Adamian ◽  
Phillip C. Song ◽  
Ramon A. Franco ◽  
Molly N. Huston ◽  
...  

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.


2017 ◽  
Vol 7 (8) ◽  
pp. 794-800 ◽  
Author(s):  
Barrett S. Boody ◽  
Brett D. Rosenthal ◽  
Tyler J. Jenkins ◽  
Alpesh A. Patel ◽  
Jason W. Savage ◽  
...  

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.


2021 ◽  
pp. 089719002110302
Author(s):  
Amanda M. Van Prooyen ◽  
Jessica L. Hicks ◽  
Ed Lin ◽  
Scott S. Davis ◽  
Arvinpal Singh ◽  
...  

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.


2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood

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.


2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee

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.


Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Susrutha Kotwal ◽  
Mehdi Fanai ◽  
Wei Fu ◽  
Zheyu Wang ◽  
Anand K. Bery ◽  
...  

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.


2013 ◽  
Vol 8 (1) ◽  
pp. 76
Author(s):  
Mathew Stone

A Review of: Gardois, P., Calabrese, R., Colombi, N., Lingua, C., Longo, F., Villanacci, M., Miniero, R., & Piga, A. (2011). Effectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarian. A randomised controlled trial. Health Information and Libraries Journal, 28(4), 273-284. doi: 10.1111/j.1471-1842.2011.00957.x Objective – To establish whether the assistance of an experienced biomedical librarian delivers an improvement in the searching of bibliographic databases as performed by medical residents and interns. Design – Randomized controlled trial. Setting – The pediatrics department of a large Italian teaching hospital. Subjects – 18 pediatric residents and interns. Methods – 23 residents and interns from the pediatrics department of a large Italian teaching hospital were invited to participate in this study, of which 18 agreed. Subjects were then randomized into two groups and asked to spend between 30 and 90 minutes searching bibliographic databases for evidence to answer a real-life clinical question which was randomly allocated to them. Each member of the intervention group was provided with an experienced biomedical librarian to provide assistance throughout the search session. The control group received no assistance. The outcome of the search was then measured using an assessment tool adapted for the purpose of this study from the Fresno test of competence in evidence based medicine. This adapted assessment tool rated the “global success” of the search and included criteria such as appropriate question formulation, number of PICO terms translated into search terms, use of Boolean logic, use of subject headings, use of filters, use of limits, and the percentage of citations retrieved that matched a gold standard set of citations found in a prior search by two librarians (who were not involved in assisting the subjects) together with an expert clinician. Main Results – The intervention group scored a median average of 73.6 points out of a possible 100, compared with the control group which scored 50.4. The difference of 23.2 points in favour of the librarian assisted group was a statistically significant result (p value = 0.013) with a 95% confidence interval of between 4.8 and 33.2. Conclusion – This study presents credible evidence that assistance provided by an experienced biomedical librarian improves the quality of the bibliographic database searches performed by residents and interns using real-life clinical scenarios.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared


Author(s):  
Garden Tabacchi ◽  
Giuseppe Battaglia ◽  
Giuseppe Messina ◽  
Antonio Paoli ◽  
Antonio Palma ◽  
...  

Background: The importance of assessing “food literacy” since youth has been highlighted and, to this purpose, valid and consistent instruments are needed. This study aimed to assess the validity and internal consistency of the preschool-FLAT (Food Literacy Assessment Tool). Methods. 505 children from 21 kindergartens, recruited within the Training-to-Health Project in Palermo (Italy), underwent oral sessions and activities on food-related aspects. Their knowledge/skills were recorded in the preschool-FLAT. The following scale measures were assessed: Content validity; internal consistency (Chronbach’s alpha coefficients); construct validity (Structural Equation Modeling—SEM); discriminant validity (intervention subgroup of 100 children vs. control group of 27 children). Results. Acceptable content validity of a 16-items scale and overall adequate internal consistency were revealed: Content validity index (CVI) 0.94, content validity ratio (CVR) 0.88, Chronbach’s alpha 0.76. The SEM revealed a 4-factor model fitting the data well (comparative fit index 0.939, root mean square error of approximation 0.033). Discriminant validity was good (intervention group scoring higher than control, p < 0.001, unpaired Student’s t-test). Conclusion. The preschool-FLAT revealed good psychometric properties, adequate validity and internal consistency. This is the only instrument in the literature specifically targeted to 3–6 years old children that could be effectively used to assess food literacy.


2014 ◽  
Vol 32 (20) ◽  
pp. 2166-2172 ◽  
Author(s):  
Maiko Fujimori ◽  
Yuki Shirai ◽  
Mariko Asai ◽  
Kaoru Kubota ◽  
Noriyuki Katsumata ◽  
...  

Purpose The aim of this study was to identify the effects of a communication skills training (CST) program for oncologists, developed based on patient preferences regarding oncologists' communication. Participants and Methods Thirty oncologists were randomly assigned to either an intervention group (IG; 2-day CST workshop) or control group (CG). Participants were assessed on their communication performance during simulated consultation and their confidence in communicating with patients at baseline and follow-up. A total of 1,192 patients (response rate, 84.6%) who had consultations with the participating oncologists at baseline and/or follow-up were assessed regarding their distress using the Hospital Anxiety and Depression Scale, satisfaction with the consultation, and trust in their oncologist after the consultation. Results At the follow-up survey, the performance scores of the IG had improved significantly, in terms of their emotional support (P = .011), setting up a supportive environment (P = .002), and ability to deliver information (P = .001), compared with those of the CG. Oncologists in the IG were rated higher at follow-up than those in the CG in terms of their confidence in themselves (P = .001). Patients who met with oncologists after they had undergone the CST were significantly less depressed than those who met with oncologists in the CG (P = .027). However, the CST program did not affect patient satisfaction with oncologists' style of communication. Conclusion A CST program based on patient preferences is effective for both oncologists and patients with cancer. Oncologists should consider CST as an approach to enhancing their communication skills.


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