Évaluation d’un enseignement multimodal intégrant du e-learning dans l’apprentissage de la réanimation et de la médecine d’urgence au cours du second cycle des études médicales

IntroductionBlended-learning methods could be a response to student nonattendance. Non-compulsory teaching combining e-learning/interactive face-to-face sessions has been implemented at Paris-Diderot Medical School for the teaching of intensive care and emergency medicine during the 2018/2019 university period. The aim of the study was to assess this newly-implemented blended teaching.MethodsQuestionnaire submitted to the 388 DFASM3 medical students present at the faculty exam of intensive care/emergency medicine. Attendance at a teaching modality was defined by the follow-up of more than half of this teaching modality. Correlations between attendance at e-learning and/or interactive face-to-face sessions, and grade were performed.ResultsA total of 358/388 (92%) students participated in this survey. A quarter of the students (88/321 – 25%) reported they usually attended at traditional lectures. Regarding blended-learning, 210/317 (67%) students reported having attended at e-learning courses and 84/321 (27%) attended at interactive face-to-face sessions. The distribution of students according to their attendance at e-learning and/or interactive face-to-face sessions was significantly different (P < 0.01). There was a significant correlation (P < 0.001) between attendance at e-learning and grade obtained at the faculty exam. Nevertheless, this correlation was also found for these students in another course taught traditionally. Overall, 309/315 (98%) students were satisfied with the blended teaching, 297/318 (93%) wanted its extent to the whole medical school's curriculum.ConclusionThe use of combined learning methods reached more students than traditional teachings and allowed the University to focus on its role of knowledge transfer.     

Implementation and effectiveness of a COVID-19 case investigation and contact tracing program at a large,urban midwestern university

BackgroundThe University of Illinois Chicago (UIC) COVID-19 Contact Tracing and Epidemiology Program was critical to the university's COVID-19 incident response during the 2020-2021 academic year. We are a team of epidemiologists and student contact tracers who perform COVID-19 contact tracing among campus members. Literature is sparse on models for mobilizing non-clinical students as contact tracers; therefore, we aim to disseminate strategies that are adaptable by other institutions.MethodsWe described essential aspects of our program including surveillance testing, staffing and training models, interdepartmental partnerships, and workflows. Additionally, we analyzed the epidemiology of COVID-19 at UIC and measures of contact tracing effectiveness.ResultsThe program was responsible for promptly quarantining 120 cases prior to converting and potentially infecting others, thereby preventing at least 132 downstream exposures and 22 COVID-19 infections from occurring.DiscussionFeatures central to program success included routine data translation and dissemination and utilizing students as indigenous campus contact tracers. Major operational challenges included high staff turnover and adjusting to rapidly evolving public health guidance.ConclusionsInstitutes of higher education provide fertile ground for effective contact tracing, particularly when comprehensive networks of partners facilitate compliance with institution-specific public health requirements.     

An expanded training program for endosonographers improved self-diagnosed accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology of the pancreas

Abstract

Objective. Rapid on-site evaluation (ROSE) of cytologic adequacy improves the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). However, on-site advice from a cytotechnologist or cytopathologist is not always available during EUS-FNA. To enhance endosonographers' ability to assess the adequacy of EUS-FNA specimens, we designed an intensive, 2-h interactive training program. The aim of this study was to determine the usefulness of the program. Methods. Four cytological pictures were selected by a trained cytotechnologist and board-certified cytopathologist from each of the seven patients who underwent EUS-FNA for pancreatic mass in Okayama University Hospital. In total, 28 pictures were used in this study. Twenty endosonographers and 14 cytologists with different levels of EUS-FNA experience evaluated cytological pictures independently before and after the training program. Results. Endosonographers' skill in evaluating the adequacy of EUS-FNA specimens was significantly improved after the completion of the training program (p < 0.001). In contrast, almost all cytologists correctly judged the adequacy of the specimens before taking the training program. Conclusions. This intensive, 2-h interactive training program is useful for endosonographers and capable of improving ROSE of EUS-FNA specimens.     

Distance Education at the Ethel Percy Andrus Gerontology Center

Abstract

The nation's first distance learning Graduate Certificate and Master's degree program as well as undergraduate courses in gerontology were developed at the Ethel Percy Andrus Gerontology Center at the University of Southern California. This article describes the beginning of the distance education program with the formation of our interactive multimedia division called Ageworks, faculty concerns about online education, faculty and student benefits, and changes in technology and costs over the first three years of program development.     

Internet parent–child interaction therapy (I-PCIT) in medically ill child: A case report

Introduction:This case illustrates the feasibility, benefit, and putative enhanced ecological validity of performing internet-parent–child interaction therapy (I-PCIT) in the parent–child dyad''s home for the treatment of behavior problems in medically ill children in the context of a global pandemic.Patient concerns:Parents of a 5-year-old girl initially presented with concerns regarding inattentiveness, physical and verbal fighting with her siblings, and getting kicked out of daycare for hitting another child. Patient also had difficulties sleeping at night.Diagnoses:Patient was diagnosed with electrical status epilepticus in sleep, frontal lobe executive function deficit, and attention deficit hyperactivity disorder.Interventions:Patient received a course of I-PCIT. Equipment included a cell phone with video capabilities connected to a videotelephony software program and set-up in the child''s home by the parents. The treatment course included 8, 1-hour, weekly teaching/coaching sessions (7 of which were performed using I-PCIT) plus 1 follow-up booster session 6 months later.Outcomes:Home-based I-PCIT implementation greatly improved disruptive behaviors in a young child with electrical status epilepticus in sleep and attention deficit hyperactivity disorder.Conclusion:A combination of I-PCIT and methylphenidate allowed her to be successful at home and in a school setting. More research is needed on PCIT adaptations, such as home-based and internet-based PCIT, for medically ill children as well as treatment protocols for combined therapies.     

Implementing an interdisciplinary intergenerational program using the Cyber Seniors® reverse mentoring model within higher education

ABSTRACT

Intergenerational service-learning in higher education positively affects older adults and students, but little is known about the effectiveness of interdisciplinary, reverse mentoring programs that use technology as the medium of bringing generations together. This study describes an intergenerational service-learning program that utilizes reverse mentoring within higher education, the “Engaging Generations Program,” at a midsized public university in New England where students help older adults learn about technology, and students gain communication and teaching skills. In this article, we outline how the program was implemented, present quantitative data on participation outcomes for students and older adults and qualitative data from older adults, and discuss best practices. Analysis of pre/post surveys found that students’ attitudes toward aging improved (p < 0.01) and older adults interest in technology improved (p < 0.05) after program participation. Best practices identified included: multiple meetings with the same pair to deepen friendships, in-person training for student leaders, student responsibility for scheduling, tailoring sessions to each participant, student documentation of meetings, and active involvement by community partners.     

Intensive pulmonary rehabilitation in a pediatric lung transplantation patient: A case report

Background:The pediatric lung transplant is a very important treatment for patients with end-stage lung diseae, and pulmonary rehabilitation (PR) is also an important factor in determining the prognosis. However, there is no much literature available on pulmonary rehabilitation in pediatric patients’ post lung transplant. Through this case report, we would like to present our intensive PR program for pediatric patients’ post-lung transplant.Patient concerns:The 10-year-old boy''s breathing before receiving a lung transplant continued to deteriorate and he eventually became dependent on a wheelchair.Diagnosis:He was diagnosed with infantile acute lymphoblastic leukemia at 6 months of age. At the age of one year, he underwent allogeneic bone marrow transplantation, but was diagnosed with post-transplantation bronchiolitis obliterans (PTBO) two months later. He had a lung transplant at the age of 10.Interventions:He was hospitalized and received an initial assessment. This assessment included functional, cognitive, and psychological evaluations. He additionally completed PR exercises twice daily for two weeks. After discharge, he continued to participate in an outpatient-based PR program for three months. During the outpatient phase, PR exercises were performed once weekly, in addition to home-based cognitive training.Outcomes:Our intensive post-lung PR program improved our patient''s exercise capacity, lung function, and quality of life. As a comprehensive rehabilitation service, our program also included a cognitive training component.Conclusion:We describe an intensive PR program tailored to pediatric patients’ post-lung transplant. The program was feasible and resulted in improvements in functional exercise capacity, lung function, and quality of life. Future research into our method is necessary for continued improvement of this novel program.     

Students report more positive attitudes toward older adults following an interprofessional service-learning course

ABSTRACT

The aim of this study was to assess undergraduate students’ perceptions of older adults over the semester in an interprofessional service-learning course that implemented a health promotion program called Bingocize® at community facilities for older adults. Students were surveyed at the beginning of the semester, at midterm, and at the conclusion of the course. Quantitative and qualitative data were collected to assess the students’ perceptions and experiences. Results suggest that a course on aging that includes interprofessional service-learning in geriatric settings is associated with a significant increase in positive perceptions of the older adult population. Further research, however, is warranted to validate the findings.     

Therapeutic patient education in heart failure: a program's assessment

Heart failure is a chronic, common and severe disease. It leads to frequent hospitalizations and decrease of patient's quality of life. A therapeutic patient education program, named “school of heart failure” was implemented at Antoine-Béclère hospital.Aim of the studyTo assess the effectiveness of this program.Patients and methodsThis therapeutic patient education program included patients with heart failure, hospitalized in a cardiology unit. Four types of evaluation were carried out: evaluation of patients’ skills before they leave the hospital, patient's knowledge (associated with the degree of certainty), satisfaction regarding the program and self-assessment of changes in their lifestyle 3 months after discharge.ResultsTwenty-four patients were included in 9 months. The program's evaluation showed promising results with respect to the acquisition of skills (94%), the improvement of patients’ knowledge associated with self-confidence increase, their satisfaction towards the program (80%) and their ability to change their habits (75%). Self-assessment has demonstrated changes in their lifestyle.ConclusionThese preliminary results are promising according to the program's effectiveness and its ability to meet patients’ educational needs. The program was certified by French authorities in 2011. Knowledge and skills acquisition will have to be confirmed on long term.     

Teaching Chinese Health Care Professionals About Community-Based Long-Term Care in China

Abstract

Academic exchanges between the U.S. and other countries around the world are increasing and teaching students abroad is part of this trend. China is in its initial stage of developing gerontology education and is in great need of new concepts and ideas for dealing with its rapidly aging population. This paper discusses the challenges and rewards of teaching gerontology to health care professionals in China. To achieve the desired learning outcomes in another country requires culturally appropriate course materials and teaching methods; drawing on students' knowledge and expertise by using an interactive format and gaining students' respect.     

Rational emotive education for reducing stress of undergraduate students of religious education program: An experimental study

Background:Rational emotive education (REE) program aims to improve the behavioral and mental health of students. This study objective was to evaluate the effect of an REE program on stress among undergraduate students of religious education program in Nigerian Universities.Method:One hundred and fifty (150) religious education undergraduates who had high level of stress participated in the study. Participants were assigned to 2 different groups. The treatment group had 75 participants and while control group also had 75 participants. Data collection was done using the Perceived Stress Scale (PSS-10) while data analysis was done using independent sample t test and paired t test statistics at .05 probability level.Results:The REE program resulted in a significant decrease in level of stress among undergraduate students of religious education program in the treatment group compared with those students in the control group. Also, the effect of the REE program was maintained during the follow-up among undergraduate students of religious education program exposed to it.Conclusion:The REE program can be used to assist undergraduate students of religious education program to manage their stress.     

Living Legends: Students' Responses to an Intergenerational Life Review Writing Program

The purpose of the study was to examine the effects of participation in the Living Legends program upon health science students' image of older adults and interest in working with older people. A multisite quasi‐experimental control group design with a connected qualitative component was used. Program sites included three Naturally Occurring Retirement Communities (NORCs) and one senior center. Health science students (n = 43) from two universities and two community colleges and community‐dwelling seniors (n = 39) participated in the program. A baseline questionnaire was used to ascertain demographic characteristics and prior type and amount of contact with older adults. The Image of Aging Scale and Likert‐style questions to measure interest in working with older adults were the primary outcome measures. Written responses to program experiences were also collected. Analysis of covariance was used to compare changes in Image of Aging subscale scores from pre‐ to posttest. Mean change in positive image of older adults subscale scores was 4.6 (SD = 4.4) for the intervention group and ?0.6 (SD = 4.8) for the control group. The difference between groups was significant (F = 22.0, P < .001), and the effect size was large (Cohen's d = 1.07). Nine of the 22 students in the intervention group had a greater interest in working with seniors after the program. Qualitative themes that emerged included a positive and beneficial experience, life lessons, seeing the person beyond the visible, power of the written word, and shared lives. Living Legends is an effective program to enhance positive images of older adults in future healthcare professionals and may have a positive impact on some students with regard to interest in working with older adults.     

Content analysis of ethical codes written by medical students compared with other codes of medical ethics

IntroductionSwearing to a medical oath is a common practice in medical schools today. Students at the Medical School for International Health (MSIH) participate in an elaborate physician's oath ceremony held in the first year of studies. At this ceremony, students read a code of ethics written by their class, the content of which includes the ethical principles the class as a whole deems significant.Methods9 codes of ethics, written by students at the MSIH between 1998 and 2006, as well as the oaths of Hippocrates and Maimonides, were collected and the principles contained within them were analyzed and compared. The oaths were broken up into preamble, covenant, code, and peroration sections, each encompassing various content domains.ResultsPrinciples discussed in both the oaths of Hippocrates and Maimonides, as well in two-thirds or more of the student-written codes, included loyalty to one's colleagues, the profession, and one's teachers, as well as acting with beneficence. Attributes including compassion, integrity, and honesty, were mentioned in two-thirds or more of the student-written codes but neither the oath of Hippocrates nor Maimonides. Controversial issues, such as abortion and discussing God were not included in codes written by students.ConclusionsEthical codes written by students at the MSIH contained some similar principles to those contained within the traditional oaths; however, there was more emphasis on attributes that establish a good physician–patient relationship in the codes written by students. Future studies need to examine the content of other student-written codes.     

From Pedagogy to Practice: Adventures in Student Engagement

ABSTRACT

With National Institutes of Health/National Institute of Aging (NIH/NIA) (R15/AREA) funding, the authors offered a four-credit hour undergraduate research course that was cross-listed in gerontology and sociology. This capstone course was aimed at providing students with the opportunity to (1) gain knowledge about diabetes and racial/ethnic disparities in the management of the illness and (2) develop expertise in secondary data analysis, using the Behavioral Risk Factor Surveillance System (BRFSS) data set. Each student designed and conducted her or his own research project and, working in teams, created a team poster and presentation. The authors examine student pretest/posttest questionnaire data, rubric-based assessment of students' work, and mid- and end-of-the-semester student evaluations to highlight three distinct aspects of the course: (1) skills acquired by students, (2) students' evaluation of the course, and (3) successes and challenges of implementing the course.     

Intervention for Nigerian preservice historians’ maladaptive academic perfectionism: Implications for history lecturers

Background:Individuals enrolled in a university program that will lead to a degree in history are considered preservice historians in the context of this study. Their goal is to become professional historians after graduating from the university. The purpose of this study was to determine whether cognitive behavioral coaching (CBC) had an effect on maladaptive academic perfectionism in Nigerian preservice historians.Method:The study included a randomized sample of 98 preservice historians from Nigerian public universities in the country''s Southeast zone [49 preservice historians were assigned to the cognitive behavioral coaching group—CBC Group, while 49 preservice historians were assigned to the waitlist control group—Waitlist control Group].Results:The finding indicate that preservice historians’ maladaptive academic perfectionism decreased significantly following cognitive behavioral coaching. There was also a significant interaction effect of time and group on the reduction of preservice historians’ maladaptive academic perfectionism.Conclusion:This study suggests that cognitive behavioral coaching is an effective intervention for preservice historians who struggle with maladaptive academic perfectionism. The study''s implications for history lecturers were discussed. Future study could investigate how maladaptive academic perfectionism affects postgraduate history students and how CBC can help them.     

Assessing Students' Learning Needs and Attitudes: Considerations for Gerontology Curriculum Planning

ABSTRACT

The growing number of older adults with multiple healthcare needs underscores the importance of teaching gerontological content to students in healthcare fields. To effectively accomplish this educational goal, it is essential to consider students' attitudes and learning needs related to caring for elderly persons. The purpose of this study was to identify prelicensure undergraduate nursing students' (N?=?200) perceived learning needs and attitudes toward older adults. Current knowledge of gerontology and attitudes were correlated with multiple variables including comfort and confidence in caring for older persons. Students identified their desire for more information on selected topics such as supportive resources for elders and their caregivers. Students who intended to learn more about gerontological nursing chose more topics; the two most commonly chosen topics were end-of-life issues and specific disorders. The data from this study can be used to design courses and curricula related to the care of elderly persons. Similar approaches to obtain student input can be adopted in designing other gerontology curricula.     

Evaluation of a Structured Predeparture Orientation at the David Geffen School of Medicine's Global Health Education Programs

Given the lack of a standardized approach to medical student global health predeparture preparation, we evaluated an in-person, interactive predeparture orientation (PDO) at the University of California Los Angeles (UCLA) to understand program strengths, weaknesses, and areas for improvement. We administered anonymous surveys to assess the structure and content of the PDO and also surveyed a subset of students after travel on the utility of the PDO. We used Fisher''s exact test to evaluate the association between prior global health experience and satisfaction with the PDO. One hundred and five students attended the PDO between 2010 and 2014 and completed the survey. One hundred and four students (99.0%) reported learning new information. Major strengths included faculty mentorship (N = 38, 19.7%), opportunities to interact with the UCLA global health community (N = 34, 17.6%), and sharing global health experiences (N = 32, 16.6%). Of students surveyed after their elective, 94.4% (N = 51) agreed or strongly agreed that the PDO provided effective preparation. Students with prior global health experience found the PDO to be as useful as students without experience (92.7% versus 94.4%, P = 1.0). On the basis of these findings, we believe that a well-composed PDO is beneficial for students participating in global health experiences and recommend further comparative studies of PDO content and delivery.     

Impact du programme d'aide au retour à domicile-insuffisance cardiaque (PRADO-IC) sur la mortalité et la réhospitalisation à un an dans une population de patients insuffisants cardiaques

IntroductionCongestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor. Since 2013, the Caisse Primaire d'Assurance Maladie (CPAM) has set up a support program PRADO-IC (support program for returning home after hospitalisation for heart failure). The aim of this study was to evaluate the impact of PRADO-IC on the heart failure readmission rate and death rate at one year.MethodsFrom September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC or not (T). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups.ResultsSix hundred and thirty-three patients were included, 262 in the PRADO-IC group and 371 in the non-PRADO group. Patients in the PRADO-IC cohort more frequently present severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (19.5% vs 16.2%, p = 0.28) are equivalent in both groups. There were no significant differences in one-year rehospitalization rate for heart failure (HF) (35.1% in PRADO cohort vs 28% in T group, p = 0.06), the time to first hospitalization (74.5 days in PRADO vs 54.5 days in T, p = 0.55) and the length of hospitalization (6.0 days in PRADO vs 7.0 days in T, p = 0.29) between the two groups. Age, hyponatremia, anemia, cancer, HF re-hospitalization were variables linked to a risk of mortality, in a multivariable analysis.ConclusionOur study shows that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are similar between the two groups.     

Disease burden,disease manifestations and current treatment regimen of the SAPHO syndrome in Germany: Results from a nationwide patient survey

BackgroundDue to diagnostic and therapeutic advances, quality of life of patients with spondyloarthritides (SpA) has improved substantially in recent years. However, little is known about how patients with the SAPHO syndrome, a heterogeneous disease counted among the SpAs, profit from these advances.ObjectiveTo investigate current aspects of patient care in a nationwide SAPHO cohort.MethodsPatients were recruited in a university centre and via a nationwide SAPHO patient support group. Medical records were reviewed and patients were asked to complete a questionnaire on the course of diagnosis, disease burden and treatment regimen.ResultsA total of 64 patients were included in the analysis. The mean time from disease onset to diagnosis was 3.8 ± 5.3 years. The patients' overall satisfaction with the course of diagnosis was 23.0 ± 28.9 on a visual analogue scale (VAS) from 0 to 100. Musculoskeletal symptoms had the highest impact on the patients' wellbeing. The mean overall disease burden on a VAS for pain was 45.4 ± 25.9. Limitations in the quality of life were reported mainly in the general health, bodily pain and vitality dimensions of the SF-36 questionnaire. Current treatments consisted of NSAIDs (77%), DMARDs (27%), glucocorticoids (23%), TNF-inhibitors (16%) and bisphosphonates (11%).ConclusionsThe SAPHO syndrome has a high impact on the patients' general health and quality of life. Establishing the diagnosis still takes years and expends multiple medical resources. Effective treatments such as TNF-inhibitors are rarely prescribed and current disease burden is not acceptable.