Depression among Emergency Medicine Residents over an Academic Year

Objectives: To describe the frequency of depression among emergency medicine (EM) residents by month, gender, rotation type, postgraduate year (PGY), and number of hours worked.
Methods: This was a prospective, nonblinded, cohort study of consenting EM residents in a four-year, 51-resident EM residency program from July 2003 to June 2004. Participants received an anonymous monthly survey via Web site that consisted of the Center for Epidemiologic Studies Depression Scale (CESD) and the resident's gender, PGY, number of hours worked in the previous week (≤40, 41–60, 61–80 and >80), and rotation type (EM, intensive care unit, non-EM clinical, or other). Residents were excluded from analysis if they did not complete at least one survey during each season. For each resident, the peak score for each three-month period was recorded and analyzed with a mixed-model analysis of variance to account for a repeated-measures effect.
Results: Fifty of 51 (98.0%) residents consented for participation. Nineteen (38%) were excluded because of incomplete data. The prevalence of depression was 12.1% (95% confidence interval [95% CI] = 7.5% to 19.0%; 15 of 124 scores). The women had numerically, but not statistically, significantly lower mean ± standard deviation CESD scores than the men (6.4 ± 6.8 vs. 8.7 ± 8.6, p = 1.0). There was no significant difference in mean CESD score by month, PGY, rotation type, or number of hours worked.
Conclusions: Season, number of hours worked, rotation type, PGY, and gender all failed to predict depression among EM residents in this single-center trial. The prevalence of depression was comparable to that of the general population.     

Evaluation of an Emergency-procedure Teaching Laboratory for the Development of Proficiency in Tube Thoracostomy

Objective : Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy.
Methods : A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20–25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest.
Results : The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002).
Conclusions : This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.     

Rate of Patient Workups by Non–Emergency Medicine Residents in an Academic Emergency Department

Objective: To quantify the number of patients seen per hour by non–emergency medicine (non–EM) residents in a university hospital ED.
Methods: This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24–hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non–EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated.
Results: The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0. 95 ± 0. 20 patients/ hour, with a range from 0. 58 to 1. 75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey–Kramer test (α = 0. 05).
Conclusion: The rate at which non–EM residents work up patients is consistent with previously reported rates for EM residents.     

Teaching Spanish to Emergency Medicine Residents

Objective: To determine the effects of teaching medical Spanish to eight PGY1 emergency medicine residents on their subsequent interactions with Spanish-speaking patients.
Methods: Eight PGY1 residents completed a 45-hour medical Spanish course administered during their first residency month. Thirty-four subsequent physician-patient interactions by these residents were audiotaped over a six-month period at a suburban teaching ED. The tapes were transcribed and analyzed for errors by a professional medical Spanish interpreter and a native Spanish speaker.
Results: Minor errors (e.g., technically incorrect grammar or vocabulary with generally appropriate patient understanding) were found in more than half of the interactions and major errors (e.g., misunderstanding duration of symptoms, misunderstanding of vocabulary) were found in 14% of the interactions. In addition, although the course was designed to supplement, not replace, professional interpreters, the residents called for an interpreter only 46% of the time.
Conclusion: Although medical language courses may be a useful adjunct to interpreters, they are not designed to replace them. Significant errors may occur when participants in such courses assume their knowledge is sufficient to obtain a good history, give patient release instructions, and provide medical care in general without an interpreter present.     

Comparison of methods of teaching children proper lifting techniques

This study was designed to determine the effects of two teaching methods on children's ability to demonstrate and recall their mastery of proper lifting techniques. Seventy-six third and fifth grade public school children were divided by grade into three groups. Two of the groups (experimental) were taught the correct method for lifting a heavy object, either by lecture demonstration or guided discovery teaching format; one group (control) was not taught. The students' knowledge was measured pretest, one-week posttest, and eight-week posttest with a written and practical test. The students in the experimental groups in both grades significantly (p less than or equal to .001) increased their scores on the written portion of the test over those of the control groups on the one-week posttest. No group, however, showed significant gains on the practical portion. No differences were found between teaching methods. Results of this study stress the importance of evaluating verbally learned motor skills in a practical application format in school settings and in clinical patient education.     

Resident Efficiency in a Pediatric Emergency Department

Objectives: To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training. Methods: For all residents rotating in an academic, urban children's hospital PED, the rate of patients seen per hour over the course of their rotation was calculated using an electronic tracking system, EmSTAT, for calendar year 2000. Rates are reported as the mean number of patients seen per resident hour worked. Mean differences are reported for resident subspecialties (emergency medicine, pediatrics, and family practice) and postgraduate year (PGY1–PGY3), and subclass comparisons were made with an analysis of variance test with Tukey's post hoc analysis. Results: A total of 153 residents (63.4% pediatric, 18.9% family practice, and 17.7% emergency medicine) saw 24,414 patients during the study period. The makeup of the group by training year was as follows: PGY1, 20.9%; PGY2, 41.2%; and PGY3, 37.9%. For all residents, the mean rate was 1.02 patients seen per hour (pph). Significant differences in the mean number of patients seen per hour by subspecialty existed, with emergency medicine residents seeing a mean of 1.12 pph, pediatrics residents seeing 1.02 pph, and family practice residents seeing 0.93 pph (mean difference, p < 0.05 for all comparisons). Rates increased by year of training, with PGY1 seeing a mean of 0.95 pph, PGY2 seeing 0.99 pph, and PGY3 seeing 1.09 pph (mean difference, p < 0.05 for all comparisons except PGY1 vs. PGY2). Conclusions: Significant differences in the rate of patients evaluated and treated in the PED exist by resident subspecialty and year of training. Knowing these rates is helpful in evaluation of resident performance, because it allows comparison with peers. Additionally, such information may be useful for residency program evaluators to gauge the amount of patient exposure for residents.     

The Development and Evaluation of a Geriatric Emergency Medicine Curriculum

Objective : To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course.
Methods : A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done.
Results : Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop.
Conclusions : The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.     

First-postgraduate-year Resident Clinical Time Use on Three Specialty Rotations

OBJECTIVE: To compare in-hospital time uses by first-postgraduate-year (PGY1) residents during rotations in emergency medicine (EM), internal medicine (IM), and surgery (S). This article reports the clinical components of residency time use. METHODS: A cross-sectional, observational study of the clinical activities of EM PGY1 residents was performed while the residents were on duty during the three specialty rotations. The activities were recorded by an observer using a log with predetermined categories for clinical activities. A time-blocked, convenience sample of resident shifts was observed for each service rotation. The sample was proportional to the total number of hours for which a PGY1 resident was expected to be in the hospital during a rotation on that service. No attempt was made to sample the same resident at all time periods or on all rotations. Proportions were compared by chi2; alpha = 0.0001. RESULTS: Twelve PGY1 residents were observed for a total of 166 hours on S, 156 hours on IM, and 120 hours on EM. These hourly amounts were representative of a typical two-week span of service on each rotation for the residents. On average, the residents spent 57% of their time on clinical or service-oriented activities. During EM and IM rotations, the residents spent most of their time performing clinical information gathering and engaging in case management and data synthesis (52% of total clinical effort). Within this category, residents on EM were more involved with case discussion and review of ancillary test results than on IM (34% vs 20% of time in this category). Conversely, proportionately less time in this category was devoted to documentation on the EM vs IM rotation (56% vs 80%; p < 0.0001). The greatest opportunity to perform procedures was on the S rotation (31% of total clinical time vs 6% for other specialties; p < 0.0001). CONCLUSION: Awareness of the clinical activities performed on PGY1 rotations can help residency directors anticipate educational needs to balance their residents' experience. Since 29% and 42% of total clinical time on PGY1 EM and IM rotations, respectively, is focused on documentation, efforts to enhance charting skills and efficiency are warranted. Also, efforts to enhance PGY1 procedural experience outside of the S rotation appear warranted.     

A Case–based Emergency Medicine Curriculum for Senior Medical Students

Objective: To determine the effects of a case–based, core content–oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students.
Methods: All senior medical students rotating through the Milwaukee County EM elective during the 1992–1993 academic year were assigned specific chapter readings from a case–oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. AH students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five–point Likert scale.
Results: Seventy–five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 ± 7.1%; final examination score 76.2 ± 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of –1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale.
Conclusions: A case–based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

Patient teaching manuals improve retention of treatment information--a controlled clinical trial in multiple sclerosis

Retention of information concerning steroid medication dosage, side effects, and course of action to follow when certain danger signs or side effects occur was tested prospectively in multiple sclerosis patients about to be treated with alternate-day steroid medication. Each patient received identical oral instruction from both a physician and a clinical nurse specialist, followed by a written pretest of the orally imparted information. Alternate patients then received a written instruction booklet to reinforce the information concerning steroid medications. After one month, a written posttest was given. Patients who received the written instructional booklet showed a significant increase in retained knowledge concerning steroids.     

Assessment of musculoskeletal examination skills: physiatry residents as evaluators and models

OBJECTIVE: To evaluate the musculoskeletal examination (MSKE) skills of junior (postgraduate year [PGY] 2) physical medicine and rehabilitation (PM&R) residents and self-confidence with these skills, and to demonstrate changes in self-confidence in the MSKE skills of senior (PGY3 and PGY4) residents, who served as evaluators and models. DESIGN: Forty-one PGY2-4 residents participated in this retrospective cohort study, which was conducted within a residency program affiliated with two medical schools. Senior residents attended an instructional session in performing and evaluating MSKE skills, taught by a musculoskeletal physiatrist. The following week, junior residents were tested on their MSKE skills; nine seniors served as models, and another nine served as evaluators. Six seniors attended the instructional session only and did not participate in the evaluation. Juniors received a posttest teaching session on MSKE skills, before an unannounced repeat evaluation 5 mos later. All residents completed a survey regarding self-confidence in MSKE skills pre- and posttest teaching sessions. Performance of MSKE skills (based on PASSOR guidelines) and application of ACGME core competencies (medical knowledge, professionalism, interpersonal skills) were measured, and a survey was administered regarding self-confidence in MSKE skills. RESULTS: Posttest results showed a significant improvement of MSKE skills among juniors in the shoulder, lumbar spine, and knee examinations (P < 0.008), with the most robust improvement in the shoulder exam (P < 0.0001). Self-confidence of juniors in their MSKE skills increased significantly (P < 0.005). There was significant improvement (P < 0.008) in self-confidence in the MSKE skills of seniors who served as models and evaluators, but not in those who only attended the instructional session (P = 0.06). CONCLUSIONS: This evaluation and instructional method resulted in a significant improvement of MSKE skills of junior residents on formal testing. Using senior residents as evaluators and models improved their confidence in their own MSKE skills.     

Resident Educational Time Study: A Tale of Three Specialties

Abstract. Objectives : To compare amounts of in-hos-pital time use by PGY1 residents during rotations in emergency medicine (EM), internal medicine (IM), and surgery. This article reports the general study methodology and focuses on the educational aspects of residency time use. Methods : A cross-sectional, observational study of the activities of EM PGY1 residents was performed while the residents were on duty during the 3 specialty rotations. The activities were recorded by an observer using a log with predetermined categories for clinical/service, educational, and personal areas. A time-blocked, convenience sample of resident shifts was observed for each service rotation. The sample was proportional to the total number of hours for which a PGY1 resident was expected to be in the hospital during a rotation on that service. No attempt was made to sample the same resident at all time periods or on all rotations. Results : Twelve PGY1 residents were observed for a total of 166 hours on surgery, 156 hours on IM, and 120 hours on EM. These hourly amounts were representative of a typical 2-week span of service on each rotation for the residents. On average, the residents spent 57% of their time on clinical or service-oriented activities, 24% on educational activities, and 19% on personal activities. The proportions of time devoted to the 3 major areas were similar for the 3 rotations. In all 3 rotations, the largest proportion of time was spent on patient-focused education (81% to 92% of total educational time). Only 2% to 11% of educational time was devoted to self-education. Within the patient-focused education category, proportionately less resident time with faculty occurred on the surgery rotation than on the EM and IM rotations (18% vs 30% and 27%, respectively). Conclusion : The general breakdowns of clinical/service, educational, and personal time use by PGY1 residents are proportionately similar for the 3 service rotations. Patient-focused education is the primary mode of education for all services. In-hospital, self-education time is limited. Clinical teaching is largely by nonfaculty. The educational implications of these findings are discussed.     

The Effects of Clinical Workload on Teaching in the Emergency Department

Background: Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching. Objectives: To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED). Methods: This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten‐point scales. A linear mixed‐effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies. Results: No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (β estimate, 0.024; p = 0.55), attending physicians' workload perception (β estimate, ?0.05; p = 0.28), patient volume in patients per hour (β estimate, ?0.010; p = 0.36), and shift type (β estimate, ?0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (β estimate, 0.12; p = 0.005), clinical teaching skills (β estimate, 0.36; p < 0.001), willingness to teach (β estimate, 0.25; p < 0.001), and interpersonal skills (β estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (β estimate, 0.007; p = 0.35). Conclusions: Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were.     

Ultrasound Training for Emergency Physicians— A Prospective Study

OBJECTIVES: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. METHODS: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. RESULTS: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean +/- SD pretest score was 15.6 +/- 4.2, 95% CI = 14. 7 to 16.5 (65% of a maximum score of 24), and the mean +/- SD posttest score was 20.2 +/- 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0. 05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 +/- 1.2, 95% CI = 20.0 to 21.4). CONCLUSIONS: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.     

The Psychological Effects of a Four-week Emergency Medicine Rotation on Residents in Training

Objective: To prospectively evaluate psychological stress reactions among residents in an emergency medicine (EM) rotation during a 4-week period.
Methods: Pre- and postrotation psychological distress levels were assessed over a 4-week EM rotation. Subjects were evaluated by several psychometric measures. These included the assessment of anxiety, depressive, and other psychological symptoms by the Brief Symptom Inventory (BSI), and the occurrence of traumatic anxiety via the Dissociative Experience Scale (DES). Also assessed were the Impact of Events Scale and the Holmes Social Readjustment Ratings Scale (Holmes), a baseline life-change measure. Demographic data were obtained. The study occurred in a university-affiliated teaching hospital ED. The 45 EM residents and 27 non-EM residents were analyzed as a group, followed by subgroup analysis comparing EM vs non-EM residents.
Results: An increase in psychological distress over the 4-week rotation was found in the non-EM group, but not in the EM group. For the non-EM residents, all 10 BSI scales worsened and 3 of 4 DES scales worsened (p = 0.002), indicative of increased psychological distress. In contrast, analysis of the 45 EM residents showed improvement in 8 of 10 BSI scales and 3 of 4 DES scales (p = 0.057).
Conclusion: A significant increase in psychologic distress was found among the non-EM residents during an EM rotation. The EM residents showed a trend for a decrease in psychological distress over the same 4-week period.     

The Use of a Dissected Bovine Heart to Teach Cardiac Sonography

OBJECTIVES: To create and test a dissected bovine heart model (BHM) to facilitate the interpretation of cardiac sonography (CS). METHODS: After a pretest and an instructional video on CS, emergency physicians (EPs) were randomized into two groups. Group 1 viewed two-dimensional (2D) anatomic pictures of human hearts. Group 2 examined the BHM and the same anatomic pictures as group 1. The EPs retook the pretest. The differences between the raw pretest and posttest scores of the groups were compared with an unpaired Student's t-test. Multiple linear regression was used to adjust for confounding by variation in education and initial test scores. EPs with previous experience in CS were excluded from the analysis. RESULTS: Thirty-five participants met the inclusion criteria, 16 in group 1 and 19 in group 2. The groups were well balanced with respect to postgraduate year training. The EPs in group 1 had a higher average pretest score of 11.6 versus 8.1 in group 2. Compared with the pretest scores, the average improvements in group 1 and group 2 were 7.6 and 11.3 points, respectively. Group 2 improved an average of 3.7 points (95% confidence interval [95% CI] = 0.7 to 6.7; p = 0.016) more than group 1. After adjusting for confounding by the difference in initial scores, group 2 improved 1.8 (95% CI = -1.1 to 4.8; p = 0.22) more points on average than group 1. CONCLUSIONS: A dissected bovine heart model did not significantly improve the ability of EPs to label structures on static ultrasounds over inspection of static-labeled anatomic pictures alone.     

Evaluating "ED STAT!": A Novel and Effective Faculty Development Program to Improve Emergency Department Teaching

Objectives Effective clinical teaching in emergency departments (EDs) presents unique challenges. No validated approaches to enhancing ED teaching have been reported. The authors evaluated the effectiveness of a novel one-day evidence-based, skills-oriented faculty development course tailored to ED teachers (ED STAT!).
Methods The authors invited all inaugural course registrants to participate in this program evaluation study. The authors assessed participants' knowledge change and perceived change in teaching behavior using a multiple-choice and short-answer question examination, a teaching behaviors questionnaire, and a survey for satisfaction. Data were gathered before, immediately after, and one month after the course. Mean scores were compared using the Wilcoxon signed rank test, and qualitative results were analyzed via a grounded theory approach.
Results Thirty-one individuals from a variety of academic and community EDs completed the May 2005 course; 28 participated in the pre-evaluation and postevaluation, and 22 participated in the one-month postevaluation. Multiple-choice scores increased from pre-evaluation to one-month postcourse by 15.1% (p < 0.001, effect size large: d = 1.53). Short-answer scores increased by 17.2% (p = 0.001, effect size large: d = 0.90). After one month, 55% of participants reported an increased amount of teaching, 86% perceived this teaching to be of a greater quality, and 82% had shared new strategies with colleagues. The course would be recommended to a colleague by 96.3% of respondents.
Conclusions ED STAT! improves participants' knowledge about ED-specific teaching strategies, and this improvement is maintained at one month. Participants reported high satisfaction and a positive effect on teaching behavior.     

The effectiveness of a staff education program on the use of continuous EEG with patients in neuroscience intensive care units

Approximately a third of patients in neuroscience intensive care units (ICUs) experience subclinical seizures and, as a result, are at higher risk for poor outcomes. The use of continuous electroencephalography (cEEG) monitoring can help nurses detect seizure activity and initiate early prevention. Nurse competency in the use of cEEG is important to facilitate effective bedside monitoring. The objective of this study was to evaluate the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. A quasi-experimental pretest/posttest 1-group design was utilized. Neuroscience ICU registered nurses, whose experience ranged from 2 months to 24 years, participated in the study. Participants completed a pretest on seizure knowledge and the use of cEEG monitoring. Participants received a 4-hour educational session on the use of cEEG monitoring. Immediately after the program and again 1 month later, they completed a posttest. Test scores improved significantly from pretest to the first posttest (t = -15.093, p < .001). Although there was a slight decline in the mean score from the posttest to the 1-month follow-up, posttest scores were significantly better than the pretest score (t = -12.42, df = 44, p < .001). Whereas years of experience correlated positively to the pretest score, after the intervention, no such correlation was evident. The results demonstrated that an educational program improved the competency of nurses in the use of cEEG with adult patients in a neuroscience ICU and that this knowledge was sustained over time. Further research is needed to demonstrate the effectiveness of this intervention in other settings.     

A fish consumption study of anglers in an at-risk community: a community-based participatory approach to risk reduction

ABSTRACT Objective: To determine the effectiveness of a community-partnered risk communication intervention tailored for subsistence anglers in a public housing community.
Design and sample: A one group, pretest, posttest design was used to test the effectiveness of the intervention in a sample ( n =23, age range 18–75 years, 100% African American) of subsistence anglers residing in a public housing community in close proximity to a Superfund clean-up site. Face-to-face surveys were conducted at baseline and 3 months post the intervention to assess changes in knowledge and behaviors.
Intervention: A socioculturally appropriate risk communication intervention was developed, implemented, and evaluated in the targeted community. The risk communication included an interactive power point presentation, visual demonstration by a role model, and distribution of low literacy written materials, followed by a booster mailing of materials 1 month past the initial intervention. Evaluation measures included survey instruments on knowledge and self-reported fishing behaviors.
Results: Participants showed improved knowledge and behavior change related to trimming fish, consumption by pregnant women and children, and consumption of large fish.
Conclusions: The sociocultured tailored risk communication intervention demonstrated promising outcomes in this community and should be evaluated in a larger population of subsistence anglers.     

Questionnaire instrument to assess knowledge of chronic kidney disease clinical practice guidelines among internal medicine residents

Introduction  The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care doctors who maybe less experienced than a nephrologist to offer optimal early CKD care. It is not known whether postgraduate training adequately prepares a future internist in CKD management.
Methods  We developed a 15-item questionnaire instrument to assess knowledge of CKD guidelines among internal medicine residents in USA using an online survey programme. We studied the validity and reliability measures of our instrument.
Results  The survey was completed by 166 PGY1 (postgraduate year one), 187 PGY2 and 126 PGY3. The questionnaire tested various aspects of CKD including definition, classification, identification of risk factors, laboratory evaluation, development of clinical action plan, identification of complications, anaemia and bone and mineral disorder, referral to a nephrologist and medication use. Validity was supported by the use of official guidelines and an expert panel of nephrologists to develop content and improvement in mean test performance with increasing level of training (PGY1 59.2 ± 13.5%, PGY2 62.6 ± 12.3% and PGY3 64.3 ± 12.2%; P  = 0.002). The reliability coefficient for the questionnaire instrument (Cronbach's α) was 0.69.
Conclusion  Our brief questionnaire is a valid and reliable instrument to assess knowledge of CKD guidelines among internal medicine residents and identify specific gaps for improvement.