Transfusion medicine education in the United States:a review for International medical audiences

Background US and international medical audiences not infrequently inquire about the US medical education system with regards to the training of transfusion medicine specialists.Methods Relevant websites were reviewed to summarize the current methods by which technologists or specialists in blood banking and physicians specializing in transfusion medicine are trained in the US.Results Specialized training in blood bank/transfusion medicine requires additional years of education and specific certifications.Medical technologists/medical laboratory specialists can pursue additional training to become technologists and/or specialists in blood banking.Similarly,physicians can pursue fellowship training in transfusion medicine.Conclusion The education of future specialists in transfusion medicine is particularly important for maintaining the field's tradition of growth and development.This is true at the level of the medical laboratory scientist and at the level of the physician.     

A survey to assess transfusion medicine education needs for clinicians

Objective: To evaluate the baseline knowledge of attending clinicians, residents and medical students in transfusion medicine (TM) at our institution in order to develop specialty‐specific lectures. Background: Physicians often receive minimal training in TM. Transfusion practices vary widely among individual physicians and across institutions. This variation leads to increased and unnecessary risk to patients and elevated costs for hospitals – problems that may be addressed through TM education. Methods: An electronic self‐administered survey was developed and administered to attending physicians, house staff and third and fourth year medical students at four hospitals. The survey consisted of 3 sections including background demographics, 14 knowledge assessment (KA) questions and opinions on educational needs. Results: Two hundred and twenty‐five surveys were received from physicians and medical students, of which 189 were completed and analysed. The overall mean score on the KA section was 31·4 ± 18·3% (4·4 ± 2·6 of 14 questions) correct. Significantly stronger performance was noted in the following categories: participants in the specialties pathology or hematology (adult and pediatric), all fellows and participants who report greater than 5 h of formal TM education in the past 5 years. The majority of participants believed that additional training in TM was needed for themselves as well as other physicians at all training levels. Conclusions: Additional training in TM would be beneficial to and welcomed by physicians in all training levels in all specialties. Innovative specialty‐specific educational programmes need to be developed and tested to ensure efficacy and durability.     

Perceived need for emergency medicine training in Pakistan: A survey of medical education leadership

Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross‐sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three‐fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country.     

Resuscitation training in developing countries: A systematic review

Objective

To evaluate whether the inclusion of any specific resuscitation training educational strategy in developing countries improves outcomes.

Methods

As part of the International Liaison Committee on Resuscitation evidence evaluation process, a systematic review of the literature was conducted. The Cochrane database of systematic reviews; Medline; Google Scholar and EmBASE were searched using multiple search strategies.

Results

Forty-four papers were relevant to review, including 38 studies that provided support for the use of resuscitation training programs in developing countries. All studies that examined self-efficacy (15 studies) and student satisfaction (8 studies) reported improvement. There was no consistent testing method for educational outcomes across studies and few studies examined both educational outcomes and patient outcome (1 of 15 self-efficacy, 0 of 18 cognitive knowledge, 0 of 8 psychomotor skills, 0 of 5 simulated operational performance). Fourteen of 15 studies that examined patient survival were either newborn or trauma resuscitation, 1 adult resuscitation, and none were in pediatric resuscitation. Increased patient survival after resuscitation training was variable, with an absolute risk reduction that ranged from 0% to 34%.

Conclusions

Resuscitation training in developing countries was well received and viewed as valuable training by the students and local counterparts. Important student, training environment characteristics, educational outcomes and patient outcomes were inconsistently defined and reported. Institution of training in trauma and newborn resuscitation in developing countries has significantly reduced mortality, but this has not been demonstrated with other training programs.     

Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study

Background

Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients.

Methods

This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24 h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion.

Results

Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5 days (1st–3rd quartile 3–8), patients received a median total of eight RBC units (1st–3rd quartile 3–17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders.

Conclusion

RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion.     

A comparison of Australasian and United States emergency medicine training programs.

Training programs in emergency medicine differ from country to country. This article compares the allopathic training programs of Australasia and the United States. The perceived advantages of these programs are highlighted, but no attempt is made to determine which is the better program. The Australasian program is significantly longer and places a greater emphasis on the basic clinical sciences, physical examination skills, and academic output. Australasian College for Emergency Medicine (ACEM) regulations are relatively flexible and allow trainees to design their own programs. Trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the United States, trainees rotate within and from one parent institution, which provides a rigid teaching structure for a "critical mass" of trainees, based on a "core" curriculum. Rotations tend to be much shorter but ensure exposure to a broader range of clinical experience. Evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. Trainees are under the close supervision of teaching faculty at all times when working in an ED.     

Transfusion Camp Rwanda: A prospective feasibility study evaluating the delivery of Transfusion Camp to a multidisciplinary group of postgraduate medical trainees in Rwanda

Background

Safe blood transfusion is an increasing priority in global health equity. The Global Health 2030 commission lists access to a safe blood supply as essential for all surgical and nonoperative patients. The objective of this study was to determine if Transfusion Camp, when modified through a collaborative partnership between experts in Canada and Rwanda, results in improved knowledge and confidence among trainees in a resource-limited setting in sub-Saharan Africa.

Methods

This prospective study took place at The University Teaching Hospital of Kigali in Rwanda. Participants were postgraduate medical trainees from departments where blood transfusion is frequent. Participants watched five prerecorded lectures and then attended a 5-hour team-based learning seminar to consolidate learning. Pre- and post-data were analyzed on transfusion knowledge and trainee confidence. A Rasch analysis investigated the performance of individual questions in assessing respondent knowledge.

Results

Of 31 trainees from surgery, anesthesia, internal medicine, and pediatrics invited to the course, 27 trainees attended the in-person team-based learning and 24 trainees completed the pre- and post-course analysis. Trainee knowledge assessment improved from (mean ± SD) 7.7/20 ± 1.95 to 10.4/20 ± 2.4 (p < .0001) and this knowledge was maintained by 12 trainees on a 3-month follow-up with a mean score of 9.3/20 ± 2.3. Trainees reported increased confidence in managing transfusion medicine-related patient issues.

Conclusion

This pilot study demonstrated that Transfusion Camp education content modified to the local context can result in increased knowledge and confidence in managing transfusion-related issues. These results will inform future planning of Transfusion Camp in resource-limited settings.     

Teaching and learning apheresis medicine: The Bermuda Triangle in Education

Apheresis Medicine has evolved markedly due to an explosion of knowledge and technology, whereas the time available for training has shrunk as curricula have become increasingly overloaded. Apheresis teaching has inherited a strong clinical context where real patient problems are used in a hands‐on environment. To optimize instruction, those involved in the education of apheresis professionals need to have (1) knowledge of how clinical laboratory medicine education has developed as a field, (2) an understanding of what is known from theory and research about how people learn, and (3) the skills to design teaching/learning activities in ways consistent with literature‐based principles of adult education. These developments in education provide a context for curriculum projects currently underway by the American Society for Apheresis. Teachers must determine which competencies are central to the essence of a trained professional. Specific, robust, learning objectives targeted toward the development of higher levels of thinking, professional attitudes, and requisite skills are formulated to guide the learner toward mastering those competencies. Curriculum is developed for each objective, consisting of content and the best teaching/learning methods to help learners attain the objective. Appropriate assessment strategies are identified to determine whether the objective is being achieved. The integration of objectives, curriculum, and assessment creates The Bermuda Triangle of Education (Richter, The Circle of Learning and Bermuda Triangle in Education, University of New Mexico School of Medicine, 2004). When educators do not effectively navigate The Bermuda Triangle of Education, learning may disappear into the murky depths of confusion and apathy. When successfully navigated, the result will be a significant learning experience that leads to transformation through education. J. Clin. Apheresis, 2010. © 2010 Wiley‐Liss, Inc.     

Evidence-based medicine training in graduate medical education: past, present and future

Evidence-based medicine (EBM) training remains a challenge to educators, particularly in graduate medical education. In this article, I trace the history of EBM in American medical education, review traditional journal clubs and contrast them to free-standing EBM curricula, petition for the advancement of integrated EBM teaching and propose an agenda for future work. Traditional journal clubs are unsuitable to teach evidence-based decision making because of their exclusive focus on critical appraisal. In contrast, EBM curricula cover the identification, appraisal and application of evidence in the context of individual patient scenarios. The effectiveness of some recent efforts reflects increasing attention to curriculum development principles and scientific rigour. The integration of EBM training into residents' established clinical venues offers theoretical educational advantages and confronts the challenge of practising EBM under the imperatives of 'real time' patient care. Initial responses to this formidable challenge show promise, but their feasibility and effectiveness remain to be explored. A more complete understanding of the epidemiology of residents' emerging clinical questions will inform continued curriculum development in integrated EBM training.     

网络通讯平台在检验科继续教育中的应用与研究

随着网络平台的普及和线上教学软件的推广,探讨其在检验科员工继续教育工作中的应用情况。应用网络通讯平台在人员管理、考勤统计、专业理论和技能培训、对分课堂教学方案应用、三基培训考核和生物安全等质量体系培训中均取得了较好的效果,有效增强了“教”与“学”的双方沟通,提高了教学的时效性,提高了参与者的学习兴趣和主观能动性。基于网络通讯平台的教学工具是检验医学专业传统继续教育模式的有益补充。     

Technology usage for teaching and learning in nursing education: An integrative review

BackgroundThe increasing availability of technology devices or portable digital assistant devices continues to change the teaching-learning landscape, including technology-supported learning. Portable digital assistants and technology usage have become an integral part of teaching and learning nowadays. Cloud computing, which includes YouTube, Google Apps, Dropbox and Twitter, has become the reality of today’s teaching and learning and has noticeably improved higher education, including nursing education.ObjectivesThe aim of this integrative literature review was to explore and describe technology usage for teaching and learning in nursing education.MethodA five-step integrative review framework by Whittemore and Knafl was used to attain the objective of this study. The authors searched for both empirical and non-empirical articles from EBSCOhost (health information source and health science), ScienceDirect and African Journals Online Library databases to establish what is already known about the keywords. Key terms included in literature search were coronavirus disease 2019 (COVID-19), digital learning, online learning, nursing, teaching and learning, and technology use.ResultsNineteen articles were selected for analysis. The themes that emerged from this review were (1) technology use in nursing education, (2) the manner in which technology is used in nursing education, (3) antecedents for technology use in nursing education, (4) advantages of technology use in nursing education, (5) disadvantages of technology use in nursing education and (6) technology use in nursing education amidst COVID-19.ConclusionTechnology in nursing education is used in both clinical and classroom teaching to complement learning. However, there is still a gap in its acceptance despite its upward trend.ContributionThe findings of this study contribute to the body of knowledge on the phenomenon of technology use for teaching and learning in nursing education.     

Interpersonal and communication skills development in general nursing preceptorship education and training programmes: A scoping review

AimThe aim of this systematic scoping review is to examine and synthesise the available literature on developing interpersonal and communication skills in general nursing preceptorship education programmes.BackgroundHighly developed interpersonal and communication skills are an essential component of nursing preceptorship. Preceptors are integral in facilitating, guiding, and developing positive interpersonal relationships between the nursing student (the preceptee), the qualified nurse (the preceptor), and patients. They also have a responsibility to foster and develop preceptees' interpersonal and communication skills and assess and deem preceptees as competent in such skills. Furthermore, preceptors require effective interpersonal and communication skills to carry out key responsibilities of their role, including creating a safe clinical learning environment, teaching, and providing effective feedback.DesignA scoping review was conducted using the methodological framework of Arksey and O'Malley. The PRISMA Extension for Scoping Reviews guided the reporting.MethodsFive electronic databases were searched for relevant articles in consultation with a librarian, supplemented by hand-searching and internet searches for grey literature. A total of 19,431 potentially relevant articles published between Jan 2000 and August 2021 were retrieved from the initial search, and an additional six articles were obtained from the supplemental search. A total of 146 articles were independently reviewed by two researchers, resulting in 24 articles eligible for inclusion in the review.ResultsSeveral themes were identified in the literature that influenced the development of interpersonal and communication skills in preceptorship education and training programmes, including design and development of programmes, key learning outcomes, pedagogical approaches of preceptorship education and training programmes and interpersonal & communication skills development in preceptorship education and training programmes. ConclusionsThis review highlighted that research on developing interpersonal and communication skills amongst preceptors is mainly absent from the literature. Further research to address these knowledge gaps is warranted. The results from this review can be used to inform future curriculum design and development of nursing preceptorship education and training programmes.