Basic and immediate paediatric cardiopulmonary resuscitation training in medical students

BackgroundTo analyse the effectiveness of Paediatric Basic Life Support (PBLS) and Paediatric Immediate Life Support (PILS) courses to train medical students in paediatric cardiopulmonary resuscitation (CPR).MethodsEighteen courses (13 in PBLS and 5 in PILS) were delivered to 1214 medical students. Two theory tests and one practical test were performed. Students filled in an anonymous questionnaire after each course.ResultsThe mean scores (out of 20) in the theory tests of the PBLS course were 11.4 before the course, and 19.2 upon completion (P < 0.0001). Infant BLS skills were achieved by 98.4% of students, and children BLS skills by 97% of them. The mean scores (out of 30) in the PILS courses were 17.3 before the course, and 29.1 at the end of the course (P < 0.0001). PBLS skills were achieved by 99% of students and PILS skills by 98.3% of them. The scores (out of 5) in the anonymous questionnaire were: theory classes, 4.5; teaching methods, 4.5; practice sessions, 4.7; instructor teaching skills, 4.8; and coordination of theory and practice and between instructors, 4.7. There were no significant differences between basic and intermediate CPR courses.ConclusionsPBLS and PILS courses are useful methods for delivering theory and practice training to medical students, and should be mandatory in the paediatric curriculum of medical studies.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

The effect of multimedia-based education on students’ anger management skill

IntroductionAnger leads to behaviors that cause a lot of damage. Life skills training can be effective in controlling anger because anger is due to a lack of skills and unpredictability of the situation. The present study aimed to determine the effect of multimedia-based education on students’ anger management skill.Material and methodsThe quasi-experimental study was performed on 88 students of Anesthesiology, Nursing, Midwifery and Operating Room of North Khorasan Nursing and Midwifery School. The educational content was screened through the monitor in front of the main hall of the Nursing & Midwifery School during the students’ attendance for one week. Students’ anger control skills were assessed by tests paired T-test, independent T-test and one-way ANOVA. Data were analyzed using spss16 software.ResultsThe mean age of the students was 20 ± 2.3. Regarding the effect of multimedia-based education on students’ anger control skills, the mean of anger control score was 24.61 ± 2.83 (Min = 11 and Max = 33) before the intervention, and 28.64 ± 2.40 after the intervention. There was a significant difference in mean scores before and after the intervention (P = .000).ConclusionMultimedia-based education has been effective in controlling students’ anger. Given the effect of multimedia-based education on anger control skills, this approach can be used to teach other essential topics to students, including life skills, especially in health science students.     

Análisis de la ansiedad en los primeros encuentros clínicos: experiencias utilizando la simulación clínica en estudiantes de pregrado

IntroductionThe first clinical encounters trigger strong feelings and emotions in medical students, when facing complex illnesses, and by feelings of guilt of «using patients’ sufferings» for their learning purposes. Clinical simulation offers them an opportunity for experiencing anxiety in a safe environment prior to being involved in the hospital. The objective of this work was to assess the level of anxiety in the first clinical encounters through clinical simulation experiences in undergraduate students.Material and methodsWe used the Inventory of Anxiety in Clinical Simulation Scenarios in a sample of 49 students. This instrument is made up of 25 items grouped into 7 factors. ANOVA test was considered to evaluate the trends by factor, for the analysis of the data.ResultsWe found an average of 2.67. In considering the gender as a factor, significant difference was obtained by using ANOVA (P = 0.016). The results of trends by factor show significant differences in corporal expressions (P = 0.003), concern about how others perceive me (P = 0.007) and worries about self-image (P = 0.019).DiscussionAssessment is of great value in medical school programs, where it becomes one of the vital elements in designing each activity developed throughout the career. Anxiety is present along the training program, having a positive or negative impact on student learning and performance, according to the way it is handled. Assessing knowledge and skills is imperative, therefore both anxiety and assessment go hand in hand. Different types of assessment can generate different levels and manifestations of anxiety in students.     

Translation into Spanish and validation of feedback in medical education questionnaire (FEEDME-Culture) during clinical rotations

IntroductionThe Feedback-Culture in Medical Education questionnaire is a validated scale to determine students’ perceptions of feedback culture in English-speaking countries. The objective of this work is to validate this questionnaire in its Spanish language version for Peruvian medical students during a clinical rotation.MethodsAn observational, instrumental-type analytical study was conducted on 139 medical students. The validity of the scale was determined by means of the Aiken's V coefficient and confidence intervals. Factorial analysis tests and Cronbach's alpha were performed.ResultsAll values were statistically significant when evaluated with Aiken's V coefficient. In addition, the asymmetry and kurtosis of all items are adequate as they do not exceed the range >±1.5. The significance of the Barlett sphericity test (1521.8; gl = 120; p = 0.001) and the Kaiser Meyer-Olkin coefficient (KMO = .953) were adequate and exploratory factor analysis revealed a two-factor structure. Cronbach's α coefficient of the total scale and its factors was higher than 0.80.ConclusionsThe Feedback-Culture in Medical Education – Spanish questionnaire is a valid scale to evaluate the perception about feedback culture in medical students who are doing a clinical rotation.     

Early postoperative predictors of satisfaction following total knee arthroplasty

BackgroundDespite the excellent total knee arthroplasty (TKA) results reported using traditional outcome measures, dissatisfaction rates of up to 30% are reported following surgery. Although several preoperative factors have been identified as possible predictors of satisfaction, there is conflicting evidence. Identification of dissatisfaction in the early postoperative assessment may therefore be an alternative consideration.MethodsWe examined the relationship between 12-month satisfaction, and early post-operative outcomes in a cohort of 486 TKA patients. Preoperative, and postoperative outcome measures at 3- and 12-months (Oxford knee score, pain score, SF12, and knee motion), were analysed and compared between patients who were satisfied and dissatisfied at 12-months following TKA. Mean scores, and postoperative change in scores were calculated. Postoperative outcomes were examined for correlation with satisfaction, and multivariate logistic regression models used to identify potential predictors of dissatisfaction.ResultsOverall satisfaction was 77.0%. No preoperative differences were observed between groups. Dissatisfaction was associated with worse postoperative status across all outcome measures (p < 0.001), except the 3-month SF12-physical component (p = 0.052). Dissatisfied patients demonstrated minimal further improvement or even worsening of outcome scores between 3- and 12-months postoperatively (p < 0.02). Both the 3-month OKS (OR = 1.15, p < 0.001), and knee flexion (OR = 1.03, p = 0.009) were significant predictors of subsequent 12-month satisfaction.ConclusionsDissatisfaction following TKA is associated with worse outcomes as early as 3 months following surgery, with minimal further improvement subsequently achieved at 12-months. Early postoperative assessment following TKA should therefore be considered, including clinical assessment, to identify those patients at risk of dissatisfaction.     

Designing,delivering and evaluating a distance learning nursing course responsive to students needs

Background and purposeThe majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources.MethodsParticipants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured.ResultsThe final sample included 25 students in the distance section and 35 in the hybrid section (N = 60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p < .05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80 ± 8.2) was significantly higher than the hybrid section (72.2 ± 9.5), (t = 3.5, p < .05).ConclusionsThe use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.     

Correlation between academic motivation and professional identity in medical students in the Faculty of Medicine of the Universitas Gadjah Mada Indonesia

Background

Professionalism is a skills area that should be mastered by medical graduates. The period of formal education is essential for the formation of professionalism. The involvement of internal factors, such as academic motivation, and external factors, such as the learning environment, might play a role in the development and learning of professional identity.

Specifying the effects of physician's communication on patients’ outcomes: A randomised controlled trial

ObjectiveTo experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.MethodsUsing a 2 × 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants’ outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.ResultsPositive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).ConclusionBeing empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients’ outcomes for the best.Practice implicationsContinued medical training is needed to harness placebo-effects of medical communication into practice.     

Effectiveness of “fill in the blanks” over multiple choice questions in assessing final year dental undergraduates

Background

Possibility of guessing in Multiple Choice questions (MCQ) when assessing undergraduates is considered a weakness. There are limited studies on the use of “Fill in the Blanks” (FIB) to overcome this issue.

Clinical Reasoning Training based on the analysis of clinical case using a virtual environment

IntroductionStudents experience difficulties defining a sequential order and analyzing variables when solving a clinical problem on real-time. Learning in a virtual environment using PBL and e-learning promotes hypothesis-generating research and case study through clinical reasoning.MethodsTwenty-two physical therapy students enrolled in a Clinical Reasoning course were asked to solve virtual clinical cases that included three different fields: orthopedic, cardiovascular/pulmonary and neurological. To evaluate the intervention, students’ perception as well as their lecture/lab academic performance, were considered.ResultsAn increase in academic performance in both lecture and lab average grades in comparison to previous years (ANOVA test, *p < 0.05). Fifty-eight percent of students reported prior study, critical thinking and technical language were aspects improved by this resource. Half of the enquired subjects also reported not having enough time to solve cases and suggested be given more adequate feedback.ConclusionsAfter this experience, teacher's role as a facilitator in the teaching learning process, putting the student in a leading role by using metacognitive strategies in tune with technology. Case-solving presents an advantage by improving the process of hypothesis-generation based on the information gathered from a case study problem. Early introduction of teaching strategies promote a systematic practice such as critical thinking through case study, and debate about the feedback needed for its achievement.     

Incremento de síndrome de burnout en estudiantes de Medicina tras su primer mes de rotación clínica

IntroductionIt has been demonstrated that the development of burnout in physicians begins during their academic training and it can affect their personal life.ObjectiveTo evaluate the prevalence of burnout in medical students at the beginning, and after one month of clinical rotation.Materials and methodsWe evaluated students at the beginning of surgical clinical rotation and one month after using the Maslach Burnout Inventory-Human Services Survey. The prevalence and differences between the 2 measurements were calculated.ResultsTwenty-one (12.3%) students showed symptoms of severity at the beginning, and 34 (19.8%) after the first month (P = .059). After eliminating the personal accomplishment scale, 54 (31.6%) and 76 (44.2%) students had severity of symptoms in the rest of the dimensions at the beginning and after one month, respectively (P = .016).ConclusionMedical students showed an increase in the presence of severe burnout, as well as emotional exhaustion and depersonalisation after one month of clinical rotation.     

The emotional and cognitive impact of the unexpected death in the simulation lab

IntroductionThe impact of animal death on surgeons during training in laparoscopic techniques is unknown.MethodsEmotions and cognitive load were assessed depending on animal survival.ResultsThose exposed to animal death (n = 14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21 ± 12.865 in the exposed and 64.74 ± 14.632 in the non-exposed (p > 0.05).ConclusionsEmotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure.     

The impact of medical informatics on patient satisfaction: A USA-based literature review

PurposePatient satisfaction is increasingly recognized as an important component of quality. The expansion of health information technologies (HIT) might have an impact on patient satisfaction – either positively or negatively. We conducted a literature review to explore the impact of these technologies on patient satisfaction.MethodsThe database of PubMed was searched from inception through May 2010, using the MeSH terms “Medical Informatics” and “Patient Satisfaction”. We included all original interventional studies regardless of their study design that were published in English and were evaluating HIT impact on patient satisfaction. Studies were categorized by technology type according to the American Medical Informatics Association framework and by study design. The major outcome of interest was the HIT impact on patient satisfaction.ResultsOf 1293 citations reviewed, 56 studies met our inclusion criteria. Design of these studies included mostly randomized controlled trials (RCTs) (n = 20, 36%), cross-sectional surveys (n = 17, 30%), and a pre and post studies (n = 14, 25%). Overall, 54% (n = 30) of the studies demonstrated a positive effect of HIT on patient satisfaction, 34% (n = 19) failed to show any effect, 11% (n = 6) had inconclusive results, and 2% (n = 1) revealed a negative effect. Of the 20 RCTs, 40% (n = 8) showed a positive effect of HIT on patient satisfaction, 50% (n = 10) failed to show any effect, and 10% (2) had inconclusive results.ConclusionsAnalysis suggested that while there is some evidence that HIT improves patient satisfaction, studies in this literature review, and in particularly RCTs, were not consistent in their findings. Although HIT may be a promising tool to improve patient satisfaction, more well-designed research studies are needed in order to get a better understanding of this domain and accordingly find new opportunities to improve quality of care.     

Implementation and outcomes of telephone disclosure of clinical BRCA1/2 test results

ObjectivesWith an increasing demand for genetic services, effective and efficient delivery models for genetic testing are needed.MethodsIn this prospective single-arm communication study, participants received clinical BRCA1/2 results by telephone with a genetic counselor and completed surveys at baseline, after telephone disclosure (TD) and after in-person clinical follow-up.ResultsSixty percent of women agreed to participate; 73% of decliners preferred in-person communication. Anxiety decreased from baseline to post-TD (p = 0.03) and satisfaction increased (p < 0.01). Knowledge did not change significantly from baseline to post-TD, but was higher post-clinical follow-up (p = 0.04). Cancer patients had greater declines in state anxiety and African-American participants reported less increase in satisfaction. 28% of participants did not return for in-person clinical follow-up, particularly those with less formal education, and higher post-disclosure anxiety and depression (p < 0.01).ConclusionsTelephone disclosure of BRCA1/2 test results may not be associated with negative cognitive and affective responses among willing patients, although some subgroups may experience less favorable responses. Some patients do not return for in-person clinical follow-up and longitudinal outcomes are unknown.Practice implicationsFurther evaluation of longitudinal outcomes of telephone disclosure and differences among subgroups can inform how to best incorporate telephone communication into delivery of genetic services.     

Patient perception of methadone dose adequacy in methadone maintenance treatment: The role of perceived participation in dosage decisions

ObjectiveIn clinical practice, methadone maintenance treatment (MMT) entails tailoring the methadone dose to the patient’s specific needs, thereby individualizing treatment. The aim of this study was to identify the independent factors that may significantly explain methadone dose adequacy from the patient's perspective.MethodSecondary analysis of data collected in a treatment satisfaction survey carried out among a representative sample of MMT patients (n = 122) from the region of La Rioja (Spain). As part of the original study protocol, participants completed a comprehensive battery to assess satisfaction with MMT, psychological distress, opinion of methadone as a medication, participation in dosage decisions, and perception of dose adequacy.ResultsMultivariate binary logistic regression showed that the only variable independently associated with the likelihood of a patient perceiving methadone dose as inadequate was the variable perceived-participation in methadone dosage decisions (OR = 0.538, 95% CI = 0.349–0.828).ConclusionPatient participation in methadone dosage decisions was predictive of perceived adequacy of methadone dose beyond the contribution of other socio-demographic, clinical, and MMT variables.Practice implicationsPatient participation in methadone dosage decision-making is valuable for developing a genuinely patient-centred MMT.     

Measuring content overlap during handoff communication using distributional semantics: An exploratory study

ObjectiveWe develop and evaluate a methodological approach to measure the degree and nature of overlap in handoff communication content within and across clinical professions. This extensible, exploratory approach relies on combining techniques from conversational analysis and distributional semantics.Materials and methodsWe audio-recorded handoff communication of residents and nurses on the General Medicine floor of a large academic hospital (n = 120 resident and n = 120 nurse handoffs). We measured semantic similarity, a proxy for content overlap, between resident-resident and nurse-nurse communication using multiple steps: a qualitative conversational content analysis; an automated semantic similarity analysis using Reflective Random Indexing (RRI); and comparing semantic similarity generated by RRI analysis with human ratings of semantic similarity.ResultsThere was significant association between the semantic similarity as computed by the RRI method and human rating (ρ = 0.88). Based on the semantic similarity scores, content overlap was relatively higher for content related to patient active problems, assessment of active problems, patient-identifying information, past medical history, and medications/treatments. In contrast, content overlap was limited on content related to allergies, family-related information, code status, and anticipatory guidance.ConclusionsOur approach using RRI analysis provides new opportunities for characterizing the nature and degree of overlap in handoff communication. Although exploratory, this method provides a basis for identifying content that can be used for determining shared understanding across clinical professions. Additionally, this approach can inform the development of flexibly standardized handoff tools that reflect clinical content that are most appropriate for fostering shared understanding during transitions of care.