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.     

Off the record: Substance-related disorders in the undergraduate medical curricula in Ireland

Background: Substance use disorders (SUDs) are a worldwide problem, and have become a major health concern in Ireland particularly. We aimed to determine the extent to which addiction medicine is embedded in the undergraduate medical curriculum in Ireland. Methods: To further investigate the degree to which drug addiction is taught in the Irish medical curriculum an online literature search was performed using Google Scholar, PubMed (from 2009 to present), EMBASE, PsycINFO, CINAHL, and Medline using the keywords “substance-related disorders,” “undergraduate,” “curriculum” and “Ireland.” Additionally, all Irish medical school websites were examined (n = 6), and a Google search and manual searches of conference programs were performed. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to systematically review and discuss findings. Results: A total of zero published studies met the criteria for inclusion in an updated systematic literature search of addiction medicine education in the undergraduate medical curriculum in Ireland. Conclusion: There is currently no documentation of drug addiction teaching sessions in Irish medical schools. Investigations that offer direct contact with medical schools, such as a telephone survey, may provide a more accurate representation of how addiction medicine education is incorporated into the medical school curricula.     

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.     

Informed consent for blood transfusion as a transfusion medicine educational intervention

SUMMARY. The aim here was to determine the effectiveness of a transfusion medicine educational intervention in a medicine core clerkship program.
Third-year medical students enrolled in their medicine core clerkship rotations at tertiary care hospitals affiliated with our institution underwent a two-part educational intervention that incorporated a transfusion medicine curriculum within the context of the medicolegal, ethical and educational elements of informed consent. Part one was a 1-h didactic session on standards of practice for red blood cell transfusion. Part two was a 90-min multidisciplinary workshop on informed consent. The effectiveness of the educational intervention was analysed by an objective structured clinical evaluation.
The student group receiving the educational intervention scored significantly higher than in the comparison group (65.8 ± 9.2 vs. 54.1 ± 10.56, P <0.001). When student scores were used to determine changes in student response patterns over time, the largest change occurred in identifying possible other options to allogeneic blood transfusion.
These results suggest that a transfusion medicine curriculum using an informed consent model can be used effectively as an educational intervention in a medicine core clerkship programme.     

Becoming an emergency medicine resident: a practical guide for medical students

A medical student interested in Emergency Medicine (EM) will find acceptance into residency to be competitive and possibly difficult. An applicant should become aware of the qualities valued by EM residency directors. In the pre-clinical years, an applicant should do well in the basic sciences, perform well on the United States Medical Licensing Examination (USMLE) Step 1, and find an appropriate EM mentor. In the clinical years, excellence in the third-year core clerkships and the EM rotations, as well as the USMLE Step 2, are very important. The student must then acquire strong letters of recommendations from supervisors and a Dean's letter that accurately reflects the student's academic record. Preparation for a residency interview involves an understanding of both opportunities and challenges in the specialty. Coupled with a strong academic record, this gives the best chance for a favorable match.     

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.     

Assessment of physicians knowledge in transfusion medicine, Iran, 2007

Knowledge of physicians has an important role in optimal use of blood products. This study was carried out to assess Iranian physicians' knowledge in transfusion medicine. In this cross-sectional study, 1242 physicians were selected through multistage sampling method in March 2007. Physicians' knowledge was assessed by the questionnaire comprising of 50 questions addressing basic knowledge, clinical aspects of blood use and transfusion reactions. One point was awarded for each correct answer. Approximately 22%, 37%, and 40% of the questions referring to basic knowledge, clinical aspects of blood use and transfusion reactions, respectively, were replied correctly. Thirty three percent came out to be the average figure for the questions receiving correct answers. Knowledge score of the specialists who were more frequently involved in blood use was not significantly different from other specialists (radiologists or psychiatrics) and general practitioners. Knowledge score decreased with increasing years in practice ( P < 0.001). Ninety nine percent of physicians under the study believed that they required special education to raise their transfusion medicine knowledge. Knowledge of physicians was about one-third lower than the expected level. Therefore, educational materials concerning transfusion medicine should be provided for medical students, residents and fellows. For practicing physicians, continuous medical education programmes should be offered so that the level of transfusion medicine knowledge can be improved.     

Learning transfusion medicine through scoring objective structured clinical examination

Background

Transfusion medicine education at the undergraduate level is typically limited in duration. In view of limitations of traditional teaching methods, we explore effectiveness of scoring (Objective Structured Clinical Examination) OSCE as an educational method.

Materials and Methods

The study was of a randomized interventional three group pre-test-post-test design. Participants were undergraduate medical students in their two final years. The intervention was watching and scoring 2 videotaped OSCE stations about obtaining consent for blood transfusions and assessing the ability to explain risks, benefits, and alternatives of blood transfusion. Participants were asked to assess the performance of the videotaped actor using checklists. Participants were randomized to watch and evaluate one set of videos at either the highest, intermediate, or lowest compliance with required consent elements. Main measure was performance in a knowledge test containing multiple-choice and true/false questions. This was given before (pre-test), immediately after the intervention (post-test 1), and after 8 weeks (post-test 2). Student perceptions regarding the intervention was assessed immediately after the session.

Results

Sixty-nine students were randomized. Post-test 1 results (mean 16.52, SD 1.88) were significantly greater than pre-test results (mean 11.83, SD 2.13) by group and across all groups (p < 0.001). Post-test 2 results for the complete cohort showed maintenance of significant improvement in comparison with the pre-test. The majority of students agreed that learning through scoring OSCE was an effective educational experience.

Conclusions

In the undergraduate medical setting, scoring OSCE stations may enhance learning of content discussed and evaluated in the stations.     

Headache in medical education: medical schools, neurology and family practice residencies

Objective.—To explore the extent of headache education received by medical students and residents.
Background.—Headache is a common, often severe, and sometimes disabling problem. However, 49% of sufferers do not seek professional treatment—of those who do, only 28% are very satisfied. One possible reason is limited education of physicians about headache.
Methods.—Surveys were sent to all allopathic and osteopathic medical schools, 200 family medicine residencies, and all 126 neurology residencies. Information requested included the amount and perceived adequacy of headache education and any plans to increase headache education.
Results.—Response rates were 35% to 40%. Medical school lecture hours ranged from 0 (4%) to >5 (24%) with 92% having no plans for an increase in headache education. Family Medicine residency lecture hours ranged from 1–3 (30%) to >5 (34%) and case presentations from 1–5 (23%) to >5 (41%), with 88% of program directors having no plans for increase. Neurology residency lecture hours ranged from 1–3 (11%) to >5 (64%) and case presentations from 1–5 (23%) to >10 (57%), with 80% having no plans for increase.
Conclusion.—Undergraduate medical education in headache is limited. Despite medical schools perceiving their training as adequate, both neurology and family practice residency program directors believe entering residents are inadequately prepared in headache upon entering the program.     

Current state of interprofessional education in Canadian medical schools: Findings from a national survey

Interprofessional education (IPE) is being increasingly recognised and prioritised in undergraduate medical education. While efforts are underway to integrate IPE into health professional curricula across Canada, the state of IPE in Canadian medical schools remains unclear. This study aims to assess the current practice of IPE in Canadian undergraduate medical curricula. An online survey was distributed to IPE directors (or designees) of all Canadian medical schools. The survey gathered details of the IPE experiences offered, curriculum structure, and perceived barriers to the programmes. The survey was completed by 12 of 17 Canadian medical schools and revealed that IPE is generally well represented in Canadian undergraduate medical education curricula. Reported barriers to IPE efforts included scheduling and funding limitations. By comparison, student interest was one of the least commonly cited issues. It would appear that students and faculty are interested in advancing the state of IPE in undergraduate medical education. The results of this study are crucial as IPE continues to evolve as a component of undergraduate medical curricula across the globe.     

Experiences of knowledge translation among researchers in transfusion medicine: Findings from an international survey study

Background

Translation of research knowledge is critical to ensure transfusion medicine policies and practices reflect current evidence and so effectively support the health of blood donors and recipients, as well as ensuring ongoing blood supply. The aim of this study was to investigate the barriers and facilitators of knowledge translation (KT) among transfusion medicine researchers and determine what KT supports are needed.

Study Design and Methods

An anonymous, cross-sectional survey was distributed by emailing corresponding authors of papers in four major blood journals, emailing grant recipients in the area of transfusion medicine, posting on social media, and through an international blood operator network.

Results

The final sample included 105 researchers. Participants had a positive orientation toward KT, with few perceiving KT as not relevant to their research or beneficial for their careers. However, many reported facing difficulties practicing KT due to time constraints, competing priorities, or lack of funds or resources. Fostering relationships with stakeholders was seen as a key facilitator of KT but a number of researchers expressed difficulties engaging and communicating with them. Collaboration opportunities, protected time for KT, and access to KT resources were some of the supports researchers felt were required to help their KT efforts.

Conclusion

To minimize the knowledge to practice gap in transfusion medicine and ensure findings from research lead to improved outcomes, organizations need to support researchers in their KT efforts and facilitate interactions between researchers and research end-users.     

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.     

Reporting of near-miss events for transfusion medicine: improving transfusion safety

BACKGROUND: Half of the reported serious adverse events from transfusion are a consequence of medical error. A no-fault medical-event reporting system for transfusion medicine (MERS-TM) was developed to capture and analyze both near-miss and actual transfusion-related errors. STUDY DESIGN AND METHODS: A prospective audit of transfusion-related errors was performed to determine the ability of MERS-TM to identify the frequency and patterns of errors. RESULTS: Events and near-miss events (total, 819) were recorded for a period of 19 months (median, 51/month). No serious adverse patient outcome occurred, despite these events, with the transfusion of 17,465 units of RBCs. Sixty-one events (7.4%) were potentially life-threatening or could have led to permanent injury (severity Level 1). Of most concern were 3 samples collected from the wrong patient, 13 mislabeled samples, and 22 requests for blood for the wrong patient. Near-miss events were five times more frequent than actual transfusion errors, and 68 percent of errors were detected before blood was issued. Sixty-one percent of events originated from patient areas, 35 percent from the blood bank, and 4 percent from the blood supplier or other hospitals. Repeat collection was required for 1 of every 94 samples, and 1 in 346 requests for blood components was incorrect. Education of nurses and alterations to blood bank forms were not by themselves effective in reducing severe errors. An artifactual 50-percent reduction in the number of errors reported was noted during a 6-month period when two chief members of the event-reporting team were on temporary leave. CONCLUSION: The MERS-TM allowed the recognition and analysis of errors, determination of patterns of errors, and monitoring for changes in frequency after corrective action was implemented. Although no permanent injury resulted from the 819 events, innovative mechanisms must be designed to prevent these errors, instead of relying on faulty informal checks to capture errors after they occur.     

A pilot study to assess physician knowledge in transfusion medicine

INTRODUCTION: An assessment of transfusion medicine knowledge and practice in Canada was carried out over a 3-week period. METHODS: Fifty-five questions were posed to evaluate both basic information on blood and blood products and on clinical use. The form was distributed through the Canadian Society for Transfusion Medicine with designated individuals asked to handle regional distribution. Some used provincial mailing lists, others distributed within each hospital. Approximately, 2000 forms were sent, including 500 in French. RESULTS: A total of 294 forms were returned; answers were recorded as 'correct', 'incorrect', 'no answer' or with 'added comments'. Overall, 52% of the questions were answered correctly or were answered with qualifying comments. In clinical practice questions, 63% were answered correctly or with qualifying comments. Basic knowledge questions drew correct answers in 37% of the cases. Several issues were answered poorly. The volume of an apheresis plasma unit was correctly estimated by less than 10% of respondents with many understanding the volume (500-600 mL) by as much as 300-400 mL. Anaesthesiologists responded most often (21%); few haematologists participated (4%). Provincial response varied: most were received from Ontario (30%) and British Columbia (22%). CONCLUSIONS: The answers show that clinical application of transfusion is generally accompanied by a questioning process - it is not entirely by rote. Basic knowledge about products needs improvement.