临床医学生对循证医学课程认知和态度分析

目的 对首都医科大学临床医学生学习循证医学课程的效果进行调查和评估,进而提出教学建议.方法 采用事先设计的调查问卷对该校2006级临床5年制和7年制医学生开设循证医学课程前、后在文献检索利用、循证医学常用术语掌握、学科认知态度方面进行调查,并辅以访谈法收集学生的意见进行统计分析.结果 开设循证医学课程后,医学生的文献平均阅读时间和文献检索次数较开设前明显增加(P＜0.05);循证医学实践涉及的术语理解程度在课程后也明显提高(P＜0.05);学生文献严格评价能力在5年制学生中也有明显提高(P＜0.05).在访谈中,学生建议增加文献检索和筛选文献课时,并对医学统计学内容进行复习.结论 循证医学课程的学习对学生认知和行为均有较大改变,结合案例教学法进行循证医学课程讲授具有较好的教学效果,循证医学理念和技能的学习对于临床医学生应用医学研究证据、自我学习和临床中付诸实践均有较大意义.     

Uniformed Medical Students and Residents in Emergency Medicine

“Uniformed medical students and residents” refers to medical school enrollees and physicians in training who are obligated to serve in the military after graduation or training completion. This is in exchange for 2 forms of financial support that are provided by the military for individuals interested in pursuing a career in medicine. These programs are offered namely through the Uniformed Services University of Health Sciences (USUHS) and the Health Professions Scholarship Program (HPSP). Uniformed medical school graduates can choose to serve with the military upon graduation or to pursue residency training. Residency can be completed at in-service programs at military treatment facilities, at out-service programs, at civilian residency training programs, or via deferment programs for residency training at civilian programs. Once their residency training is completed, military physicians should then complete their service obligation. As such, both USUHS and HPSP students should attend a basic officer training to ensure their preparedness for military service. In this article, we elaborate more on the mission, requirements, application, and benefits of both USUHS and HPSP. Moreover, we expand on the officer preparedness training, postgraduate education in the military, unique opportunities of military medicine, and life after completion of military obligation.     

Networking Matters: A Social Network Analysis of the Association of Program Directors of Internal Medicine

ABSTRACT

Theory: Networking has positive effects on career development; however, personal characteristics of group members such as gender or diversity may foster or hinder member connectedness. Social network analysis explores interrelationships between people in groups by measuring the strength of connection between all possible pairs in a given network. Social network analysis has rarely been used to examine network connections among members in an academic medical society. This study seeks to ascertain the strength of connection between program directors in the Association of Program Directors in Internal Medicine (APDIM) and its Education Innovations Project subgroup and to examine possible associations between connectedness and characteristics of program directors and programs. Hypotheses: We hypothesize that connectedness will be measurable within a large academic medical society and will vary significantly for program directors with certain measurable characteristics (e.g., age, gender, rank, location, burnout levels, desire to resign). Method: APDIM program directors described levels of connectedness to one another on the 2012 APDIM survey. Using social network analysis, we ascertained program director connectedness by measuring out-degree centrality, in-degree centrality, and eigenvector centrality, all common measures of connectedness. Results: Higher centrality was associated with completion of the APDIM survey, being in a university-based program, Educational Innovations Project participation, and higher academic rank. Centrality did not vary by gender; international medical graduate status; previous chief resident status; program region; or levels of reported program director burnout, callousness, or desire to resign. Conclusions: In this social network analysis of program directors within a large academic medical society, we found that connectedness was related to higher academic rank and certain program characteristics but not to other program director characteristics like gender or international medical graduate status. Further research is needed to optimize our understanding of connection in organizations such as these and to determine which strategies promote valuable connections.     

HIV Primary Care Curriculum Improves HIV Knowledge,Confidence and Attitudes

To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.     

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.     

The Emergency Physician and Knowledge Transfer: Continuing Medical Education, Continuing Professional Development, and Self-improvement

A workshop session from the 2007 Academic Emergency Medicine Consensus Conference, Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake, focused on developing a research agenda for continuing medical education (CME) in knowledge transfer. Based on quasi-Delphi methodology at the conference session, and subsequent electronic discussion and refinement, the following recommendations are made: 1) Adaptable tools should be developed, validated, and psychometrically tested for needs assessment. 2) "Point of care" learning within a clinical context should be evaluated as a tool for practice changes and improved knowledge transfer. 3) The addition of a CME component to technological platforms, such as search engines and databases, simulation technology, and clinical decision-support systems, may help knowledge transfer for clinicians or increase utilization of these tools and should, therefore, be evaluated. 4) Further research should focus on identifying the appropriate outcomes for physician CME. Emergency medicine researchers should transition from previous media-comparison research agendas to a more rigorous qualitative focus that takes into account needs assessment, instructional design, implementation, provider change, and care change. 5) In the setting of continued physician learning, barriers to the subsequent implementation of knowledge transfer and behavioral changes of physicians should be elicited through research.     

实习前临床医学生与护理学生患者安全知识调查与比较分析

目的调查并比较实习前本科临床医学生和护理学生关于患者安全知识、态度和技能的现状,为开展患者安全教育提供依据。方法以皖南医学院实习前五年制临床医学本科生和护理本科生为研究对象,进行＂患者安全知识、态度、技能＂问卷的匿名调查。采用EpiData 3.0软件录入数据,并用SPSS 17.0软件进行统计分析。结果共发放771份问卷,收回有效问卷755份,包括临床医学生320份,护理学生435份。结果显示：护理学生和临床医学生患者安全知识、态度和技能总分均较低;护理学生在＂医疗差错相关知识＂（P=0.012）、＂医疗差错发生后的情感＂（P=0.000）、＂患者安全的个人态度＂（P=0.001）和＂有关患者安全你的意向/打算＂（P=0.000）4个模块的得分均显著高于临床医学生;临床医学女生和护理女生在＂医疗差错发生后的情感＂得分上也均显著高于男生（P=0.028和0.000）。结论实习前护理学生和临床医学生患者安全知识均不足,后者更差,应加强针对他们的患者安全知识教育。     

Menopause Management Knowledge in Postgraduate Family Medicine,Internal Medicine,and Obstetrics and Gynecology Residents: A Cross-Sectional Survey

Objective

To evaluate the knowledge of and nature of training for menopause management in postgraduate residents.

A Comprehensive, Unembalmed Cadaver-based Course in Advanced Emergency Procedures for Medical Students

Background: Preparing medical students for residency in emergency medicine involves education in many areas of knowledge and skill, including instruction in advanced emergency procedures. Objectives: To outline the logistics involved in running a training course in advanced emergency procedures for fourth‐year medical students and to report students' perceptions of the impact of the course. Methods: The course is a cadaver‐based training laboratory that utilizes several teaching modalities, including a Web‐based syllabus and online streaming video, didactic lecture, hands‐on practice with models and ultrasound, and hands‐on practice with unembalmed (fresh) cadavers. The course focuses on seven emergent procedural skills, including deep venous access via the subclavian, internal jugular, and femoral veins; tube thoracostomy; saphenous vein cutdown; intraosseous line placement; and emergency cricothyrotomy. The course is taught by attending emergency physicians and anatomy department faculty. After completion of the course, students reported their self‐assessments on a five‐point Likert scale. Data were evaluated using a paired t‐test (two‐tailed). Results: Thirty‐three students completed the evaluation. The students reported a mean (± standard deviation [SD]) increase in their understanding of the indications for all procedures from 3.3 (± 1.1) before to 4.8 (± 0.4) after the course (p = 0.004, 95% CI = 0.7 to 2.0). The students reported a mean increase in their understanding of how to perform all procedures from 2.1 (± 0.9) before to 4.6 (± 0.6) after the course (p = 0.003, 95% CI = 1.9 to 3.0). The students reported a mean increase in their comfort level performing all procedures from 1.6 (± 0.8) before to 4.2 (± 0.7) after the course (p < 0.001, 95% CI = 2.0 to 2.9). Conclusions: These findings support the value of an advanced emergency procedural training course using an unembalmed cadaver‐based laboratory and incorporating several teaching modalities.     

Does Simulator Training for Medical Students Change Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department?

Objectives: To determine how simulator training impacts patients' preferences about medical student procedures in the emergency department. Methods: A questionnaire was administered to a convenience sample of 151 of 185 patients approached (82% participation) seen in the emergency department of a midwestern teaching hospital. The questionnaire asked how many procedures they would prefer a medical student have performed after mastering the procedure on a simulator before allowing the medical student to perform this procedure on them. The procedures included venipuncture, placement of an intravenous line, suturing the face or arm, performing a lumbar puncture, placement of a central line, placement of a nasogastric tube, intubation, and cardioversion. These results were compared with those of a similar study asking about the same procedures without the stipulation that the skill had been mastered on a simulator. Results: A high of 57% (venipuncture) and a low of 11% (placement of a central line) would agree to be a student's first procedure after simulator training. Except for intubating and suturing, participants were more likely (p < 0.05) to allow a medical student to perform a procedure on them after simulator training than without simulator training. Many patients prefer not to have a medical student perform a procedure no matter how many procedures the student has done (low of 21% for venipuncture, high of 55% for placement of a central line). Conclusions: Patients are more accepting of medical students performing procedures if the skill has been mastered on a simulator. However, many patients do not want a medical student to perform a procedure on them regardless of the student's level of training.     

First-Year Internal Medicine Residents' Reflections on Nonmedical Home Visits to High-Risk Patients

Problem: Patients who are high utilizers of care often experience health-related challenges that are not readily visible in an office setting but paramount for residents to learn. A nonmedical home visit performed at the beginning of residency training may help residents better understand social underpinnings related to their patient's health and place subsequent care within the context of the patient's life. Intervention: First-year internal medicine residents completed a nonmedical home visit to an at-risk patient prior to seeing the patient in the office for his or her first medical visit. Context: We performed a thematic analysis of internal medicine interns' (n = 16) written narratives on their experience of getting to know a complex patient in his or her home prior to seeing the patient for a medical visit. Narratives were written by the residents immediately following the visit and then again at the end of the intern year, to assess for lasting impact of the intervention. Residents were from an urban academic residency program in Baltimore, Maryland, USA. Outcome: We identified four themes from the submitted narratives. Residents discussed the visit's impact on future practice, the effect of the community and support system on health, the impact on the depth of the relationship, and the visit as a source of professional fulfillment. Whereas the four themes were present at both time points, the narratives completed immediately following the visit focused more on the themes of impact of future practice and the effect of the community and support system on health. The influence of the home visit on the depth of the relationship was a more prevalent theme in the end-of-the-year narratives. Lessons Learned: Although there is evidence to support the utility of learners completing medical home visits, this exploratory study shows that a nonmedical home visit can be rewarding and formative for early resident physicians. Future studies could examine the patient's perspective on the experience and whether a nonmedical home visit is a valuable tool in other patient populations.     

循证医学教学对研究生相关知识、技能、态度和行为的影响研究

目的探讨循证医学课程对医学研究生知识、技能、态度和行为的影响以及循证临床实践中的障碍,为进一步有效地开展循证医学教学和循证临床实践提供参考。方法采用封闭式问题和开放式问题相结合的自填问卷对四川大学2004年秋选修《循证医学》的111名医学研究生进行调查,比较选修前后学生在循证医学知识、技能、态度、行为,以及循证临床实践中障碍方面的差异。结果医学研究生在选修“循证医学”课程前后,其循证医学知识、技能、态度、行为,以及在循证临床实践的障碍方面有一定差异。在知识和技能方面:选修后学生对循证医学相关专业术语的理解有显著提高(75%项目差异有统计学意义),特别是对绝对危险度、系统评价、Meta分析和发表偏倚(P<0.01);认为自己在熟练使用检索工具这一技能上有所提高(P<0.05)。在态度方面:选修前,有55%左右的条目分值均较高(>4分);选修后“现在多数用于病人诊治的干预措施缺乏强有力的证据支持”和“循证医学实践需要考虑病人的意愿”这两项分值提高明显(P<0.01)。“在医疗实践中采用循证医学是合理的要求”和“循证医学不受临床实践场所的限制”这两个条目选修前后的分值都偏低(<3分),在“日常工作中需要增加医学证据的使用”和“对应用循证医学进行临床实践和改进临床技能有兴趣”两项上,分值接近。在行为方面:选修后医学生对文献的使用仍不十分重视。如选修前后都有60%左右的医学生基本上不阅读相关的专业文献。虽然检索MEDLINE和其他电子数据库次数较多(>6次/月,选修前60.3%,选修后65.7%),但在临床实践中应用却不多(>6次/月,课前仅占29%,课后仅占35.1%)。学生对临床实践指南的应用情况,选修前后差异无统计学意义。在障碍方面:选修前后学生均认为最大的障碍是严格评价文献的能力有限,但排名第2与第3的障碍有差别。选修前缺乏查询循证医学的相关技能排在缺乏信息资源前,而选修后相反。结论目前的循证医学课程对提高医学研究生循证医学知识的效果显著,对其对待循证医学的态度和行为也有一定的提高。在临床实践中,医学研究生应用循证医学的三大障碍是严格评价文献能力有限,缺乏查询循证医学相关的技能和缺乏信息资源。     

对社区居民感冒知识掌握与应对措施的调查

目的通过调查社区居民感冒知识掌握与应对措施的状况,找出存在的问题,以便有针对性地对社区居民进行健康教育。方法随机抽取2009年哈尔滨市南岗区和道里区不同层次在籍社区居民184名,采用自制问卷进行调查。结果感冒知识掌握程度不好的居民占42.93%,感冒知识掌握好的居民占57.07%;经济状况好、有医疗保险的居民对感冒的应对措施更为合理,但社区居民感冒知识掌握情况与其感冒后的应对措施无相关性（P〉0.05）。结论社区居民尤其是收入低、没有医疗保险的居民,对感冒知识的认知程度较低,面对感冒常不能及时采取正确的措施,故要加强对社区低收入群体的健康教育,指导他们正确应对感冒。     

Academic Career Development for Emergency Medicine Residents: A Road Map

As the marketplace for academic positions in emergency medicine grows more competitive, it becomes increasingly important for residents who desire academic careers to distinguish themselves during their residency. This report attempts to outline a road map for department and residency program leaders to help their houseofficers become successful candidates for an academic emergency medicine position. Specific ways a resident can enhance his or her "academic marketability" include 1) involvement in research, 2) establishment of a track record of productivity via scholarly writing, 3) awareness of the literature in the specialty, 4) involvement in specialty organizations and hospital committees, 5) competition for national awards, 6) gaining education skills, 7) developing an academic niche, and 8) fellowship training.     

The Development and Impact of a Social Media and Professionalism Course for Medical Students

Problem: Inappropriate social media behavior can have detrimental effects on students' future opportunities, but medical students are given little opportunity to reflect upon ways of integrating their social media identities with their newly forming professional identities. Intervention: In 2012, a required educational session was developed for 1st-year medical students on social media and professional identity. Objectives include identifying professionalism issues and recognizing positive social media use. The 2-hour large-group session uses student-generated social media examples to stimulate discussion and concludes with an expert panel. Students complete a postsession reflection assignment. Context: The required social media session occurs early in the 1st year and is part of the Professionalism curriculum in The George Washington University School of Medicine. Reflection papers are graded for completion. Outcome: The study began in 2012 and ran through 2014; a total of 313/505 participants (62%) volunteered for the study. Assessment occurred through qualitative analysis of students' reflection assignments. Most students (65%, 203/313) reported considering changes in their social media presence due to the session. The analysis revealed themes relating to a broader understanding of online identity and opportunities to enhance careers. In a 6-month follow-up survey of 76 students in the 2014 cohort who completed the entire survey, 73 (94%) reported some increase in awareness, and 48 (64%) made changes to their social media behavior due to the session (response rate = 76/165; 46%), reflecting the longer term impact. Lessons Learned: Opportunities for discussion and reflection are essential for transformational learning to occur, enabling understanding of other perspectives. Incorporating student-submitted social media examples heightened student interest and engagement. The social media environment is continually changing, so curricular approaches should remain adaptable to ensure timeliness and relevance. Including online professionalism curricula focused on implications and best practices helps medical students develop an awareness of their electronic professional identities.     

城乡居民健康体检前准备知识了解状况调查

目的了解城乡居民健康体检前准备知识了解状况,为实施针对性的健康教育提供依据,使每位体检者得到高质量的体检服务。方法对2006年3—8月在体检中心体检的1 600名城乡居民,用自行设计的调查问卷对其体检前准备知识了解情况、所掌握知识主要来源、喜欢接受的教育方式等问题进行调查。结果调查对象对健康体检前准备知识的了解情况总体水平比较低;所掌握的知识主要来源于单位体检前一天发放的简易的＂体检须知＂单;对体检知识的掌握程度,文化程度较高的体检者优于文化程度较低者,城镇居民优于农村居民;对知识需求率均为100%,喜欢的学习方式为录像结合医护人员讲解和示范。结论在体检前对体检者进行健康体检知识教育很重要,进行健康教育时应采取灵活多样的形式,加大对文化水平低及农村体检者的宣教力度。     

An Asynchronous Curriculum for Teaching Practical Interpretation Skills of Clinical Images to Residents in Emergency Medicine

BackgroundInterpretation of radiologic images is a critical skill for resident physicians in emergency medicine (EM), however, few training programs offer formal training in this realm. Time and money also need to be considered when adding to the curriculum of trainees.ObjectiveWe sought to determine the utilization and benefit of an asynchronous curriculum in the interpretation of diagnostic imaging.MethodsRadiologic images were obtained from emergency department patients and presented to the trainees on a weekly basis from April to December 2017; discussion questions regarding the images were posed, all via the online workplace platform Slack. Trainees were surveyed prior to and 8 months after initiation of the curriculum to ascertain their confidence with radiologic image interpretation and their use of Slack.ResultsOf the 36 potential resident physician participants in this study, 31 (86%) completed the pre-intervention survey and 28 (78%) completed the post-intervention survey. The curriculum was found to be beneficial to all respondents (100%) and increased their confidence with image interpretation from 2.93 ± 0.89 pre-intervention (5-point Likert scale) to 3.46 ± 0.83 post-intervention (p < 0.02). Seventy-five percent noted that they viewed the material “often” or “anytime new material was posted.”ConclusionsUse of an asynchronous curriculum in image interpretation increased the confidence of trainees and was well-utilized. The implications of this are far-reaching, given that a similar intervention could be undertaken for any topic in any specialty in medicine, and with no cost of money or didactic time.     

The Effects of Deliberate Practice and Feedback to Teach Standardized Handoff Communication on the Knowledge,Attitudes, and Practices of First-Year Residents

Background: Residents’ shift length reduction and communication errors in transitions of care necessitate educating residents on handoff communication. Purpose: We examined the change in knowledge, attitudes, and practices of 1st-year residents after implementing a curriculum using deliberate practice to teach handoff communication. Methods: First-year residents completed a needs assessment survey and a video assessment of handoff practices. They participated in a brief curriculum using lecture and deliberate practice with feedback to teach a standardized approach to handoff communication. Change in knowledge, attitudes, and practices were measured with survey and video assessments. Results: Eleven 1st-year residents completed the course and final assessments. Residents’ comfort with performing handoffs and their perceived efficiency indicated improvement. Practices improved, with increased inclusion of important features of handoffs (6.31 to 7.64, p < .001). Conclusions: A brief curriculum utilizing deliberate practice is an effective way to improve handoff practices of 1st-year residents.