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Vohra TT, Kinni H, Gardner-Gray J, Giles CD, Hamam MS, Folt JR. Teaching and Assessing Bedside Procedures: A Standardized Cross-Disciplinary Framework for Graduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:266-272. [PMID: 38039977 DOI: 10.1097/acm.0000000000005574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
ABSTRACT Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for bedside procedure training and implementation is available. Bedside procedure training and credentialing processes across large institutions may vary among departments and specialties, leading to variable standards, creating an environment that lacks consistent accountability, and making quality improvement difficult. In this Scholarly Perspective, the authors describe a standardized bedside procedure training and certification process for graduate medical education with a common, institution-wide educational framework for teaching and assessing the following 7 important bedside procedures: paracentesis; thoracentesis; central venous catheterization; arterial catheterization; bladder catheterization or Foley catheterization; lumbar puncture; and nasogastric, orogastric, and nasoenteric tube placement. The proposed framework is a 4-stage process that includes 1 preparatory learning stage with simulation practice for knowledge acquisition and 3 clinical stages to guide learners from low-risk to high-risk practice and from high to low supervision. The pilot rollout took place at Henry Ford Hospital from December 2020 to July 2021 for 165 residents in the emergency medicine and/or internal medicine residency programs. The program was fully implemented institution-wide in July 2021. Assessment strategies encompass critical action checklists to confirm procedural understanding and a global rating scale to measure performance quality. A major aim of the bedside procedure training and certification was to standardize assessments so that physician trainers from multiple specialties could train, assess, and supervise any participating trainee, regardless of discipline. The authors list considerations revealed from the pilot rollout regarding electronic tracking systems and several benefits and implementation challenges to establishing institution-wide standards. The proposed framework was assembled by a multidisciplinary physician task force and will assist other institutions in adopting best approaches for training physicians in performing these critically important and difficult-to-perform procedures.
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Kuchipudi YS, Rule A, Caldwell A, Fenchel M, Bosse D, Schuler CL, Jones YO. Pediatric Hospitalists' Performance of Recommended Minor Procedures: A Multicenter Study. Hosp Pediatr 2023; 13:1039-1047. [PMID: 37927058 DOI: 10.1542/hpeds.2023-007202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Performance of minor procedures is highly variable among pediatric hospitalists. Our objective was to describe procedural frequency and measure self-assessed competence in recommended minor procedures among practicing hospitalists. METHODS An electronic survey was administered across 20 US institutions. An individual survey assessed training, frequency, independence, and success in performing 11 minor procedures. The site survey described practice settings at participating study sites. The primary outcome was respondents' self-assessed competence (SAC), derived by averaging self-assessed independence and success scores (each on a 5-point Likert scale) across all 11 minor procedures. Associations between predictor variables and SAC were determined through analysis of variance for categorical variables and fitted regression models for continuous variables. RESULTS Of the 360 survey respondents, the majority were female (70%), not fellowship trained (78%), and had 10 years or fewer experience as a hospitalist (72%). Lumbar puncture and bag mask ventilation were most frequently performed. Greater procedural frequency and time since graduation from training were associated with higher SAC scores among respondents. Practice characteristics, including comanagement of patients and reserved time for practicing procedures, were associated with higher SAC scores. The presence of a simulation center and fellowship program was not associated with higher SAC scores. CONCLUSIONS Pediatric hospitalists that performed procedures more frequently had higher self-assessed procedural competence. Tailored opportunities with increased hands-on experience in performing minor procedures may be important to develop and maintain procedural skills.
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Affiliation(s)
| | - Amy Rule
- Divisions of Neonatology and Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
| | - Alicia Caldwell
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew Fenchel
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Christine L Schuler
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yemisi O Jones
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Xie S, Grimstrup S, Nayahangan LJ, Wang Z, Wan X, Konge L. Using a novel virtual-reality simulator to assess performance in lumbar puncture: a validation study. BMC MEDICAL EDUCATION 2023; 23:814. [PMID: 37904177 PMCID: PMC10614418 DOI: 10.1186/s12909-023-04806-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 10/25/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND A lumbar puncture procedure's success depends on a competent physician minimizing the risk of failing to get a sample and avoiding complications such as post-dural headache. A new virtual-reality simulator might be helpful in deciding when a physician is competent to perform lumbar puncture. We aimed to investigate validity evidence for a simulator-based test in lumbar puncture and establish a pass/fail standard to allow a mastery learning training program. METHODS Validity evidence was investigated using Messick's framework by including participants who were novices, intermediates, or experienced in lumbar puncture. Each participant performed two lumbar puncture procedures on the simulator, and fifty-nine predefined simulator metrics were automatically recorded. Cronbach's alpha was used to explore internal consistency reliability. Intergroup comparisons were made using independent sample t-tests with Tukey's correction for multiple comparisons. The learning effect was explored using paired sample t-test analysis, and a pass/fail standard was established using the contrasting groups' method. RESULTS 73 novices, 18 intermediates, and 19 physicians performed the test resulting in a total of 220 procedures. 25 metrics (42.4%) had good discriminatory ability, and the reliability of these metrics was good, Cronbach's α = 0.81. The experienced physicians were significantly better than the novices (18.3 vs. 13.3, p < 0.001), and the pass/fail standard was established at 16 points. This standard resulted in 22 (30.1%) novices passing (i.e., false positives) and 5 (26.3%) physicians failing (i.e., false negatives). CONCLUSION This study provides validity evidence for a simulator-based test of lumbar puncture competence. The test can help ensure basic competence at the end of a simulation-based training program for trainees, i.e., a mastery learning training program.
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Affiliation(s)
- Sujun Xie
- Guangzhou University of Chinese Medicine, Jichang Road 12, Guangzhou, 510405, China.
- Guangdong Academy for Medical Simulation (GAMS), No.10 Hongming Road, East District, Huangpu District, Guangzhou, 510530, China.
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Ryesgade 53B, opg. 98A, Copenhagen, 2100, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Ryesgade 53B, opg. 98A, Copenhagen, 2100, Denmark
| | - Zheng Wang
- Guangdong Academy for Medical Simulation (GAMS), No.10 Hongming Road, East District, Huangpu District, Guangzhou, 510530, China
| | - Xing Wan
- Guangzhou University of Chinese Medicine, Jichang Road 12, Guangzhou, 510405, China.
| | - Lars Konge
- Guangdong Academy for Medical Simulation (GAMS), No.10 Hongming Road, East District, Huangpu District, Guangzhou, 510530, China
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Ryesgade 53B, opg. 98A, Copenhagen, 2100, Denmark
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Clemens L. The Efficacy and Cost-Effectiveness of a Simulation-Based Primary Care Procedural Skills Training Program for Advanced Practice Providers. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00097. [PMID: 37713161 DOI: 10.1097/ceh.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training. METHODS A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed. RESULTS Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant. DISCUSSION Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.
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Affiliation(s)
- Lisa Clemens
- Dr. Clemens: Director Provider Professional Development and Simulation, Parkview Health, Fort Wayne, IN. A.T. Still University, Mesa, AZ
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Merritt C, Pusic M, Wolff M, Cico SJ, Santen SA. The Case for Core Competency and Competent Corps: Using Polarity Management to Illuminate Tensions in Training. J Grad Med Educ 2022; 14:650-654. [PMID: 36591425 PMCID: PMC9765911 DOI: 10.4300/jgme-d-22-00199.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Chris Merritt
- Chris Merritt, MD, MPH, MHPE, is Director, Medical Education Fellowship, Assistant Dean for Faculty Development, and Associate Professor of Emergency Medicine and Pediatrics, Alpert Medical School, Brown University
| | - Martin Pusic
- Martin Pusic, MD, MA, PhD, is Associate Physician, Division of Emergency Medicine, Boston Children's Hospital, and Associate Professor of Pediatrics and of Emergency Medicine, Harvard Medical School
| | - Margaret Wolff
- Margaret Wolff, MD, MHPE, is Associate Professor of Emergency Medicine and Pediatrics, University of Michigan Medical School
| | - Stephen J. Cico
- Stephen J. Cico, MD, MEd, is Assistant Dean for Graduate Medical Education, Designated Institutional Official, and Professor of Emergency Medicine, University of Central Florida College of Medicine
| | - Sally A. Santen
- Sally A. Santen, MD, PhD, is Senior Associate Dean of Assessment, Evaluation, and Scholarship and Professor of Emergency Medicine, Virginia Commonwealth University School of Medicine, and Professor, Departments of Emergency Medicine and Medical Education, University of Cincinnati
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Effectiveness of training primary care internal medicine residents in etonogestrel implants and impact on their future practice: A cross-sectional study. Contraception 2022; 115:31-35. [PMID: 35917931 PMCID: PMC9994633 DOI: 10.1016/j.contraception.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the impact of an etonogestrel implant training program within a primary care Internal Medicine residency training program. STUDY DESIGN We surveyed graduates of our primary care Internal Medicine residency program in the Bronx, New York who performed implant procedures though the first 32 months after implementation of a monthly faculty-supervised resident implant clinic. We assessed the number of implants placed and removed per graduate, and surveyed graduates' satisfaction with the implant training program, perceived competence with implant procedures, and intent and ability to perform implant procedures and barriers to performing implant procedures postgraduation. RESULTS Between July 2017 and February 2020, 14 residents placed a total of 34 devices and removed four. All 14 program graduates completed the survey in August 2020. All but one respondent felt this training was valuable and 11 felt competent placing implants without supervision. Although 10 planned to provide implants following graduation, none have been able to, largely because of credentialing and clinic-practice level barriers. CONCLUSIONS The primary care Internal Medicine program graduates we surveyed (n = 14) valued our etonogestrel implant training program and perceived competence, particularly with implant placement. However, even those who intended to provide etonogestrel implants postgraduation were unable to do so. IMPLICATIONS Internal Medicine residents trained to place and remove etonogestrel implants are most comfortable with implant placement. However, these physicians may face barriers related to credentialing and ambulatory practice scope when attempting to provide this care in clinical practice.
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Qureshi SP, Jones D, Dewar A. Physicians' Conceptions of the Dying Patient: Scoping Review and Qualitative Content Analysis of the United Kingdom Medical Literature. QUALITATIVE HEALTH RESEARCH 2022; 32:1881-1896. [PMID: 35981561 PMCID: PMC9511242 DOI: 10.1177/10497323221119939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Most people in high income countries experience dying while receiving healthcare, yet dying has no clear beginning, and contexts influence how dying is conceptualised. This study investigates how UK physicians conceptualise the dying patient. We employed Scoping Study Methodology to obtain medical literature from 2006-2021, and Qualitative Content Analysis to analyse stated and implied meanings of language used, informed by social-materialism. Our findings indicate physicians do not conceive a dichotomous distinction between dying and not dying, but construct conceptions of the dying patient in subjective ways linked to their practice. We argue that the focus of future research should be on exploring practice-based challenges in the workplace to understanding patient dying. Furthermore, pre-Covid-19 literature related dying to chronic illness, but analysis of literature published since the pandemic generated conceptions of dying from acute illness. Researchers should note the ongoing effects of Covid-19 on societal and medical awareness of dying.
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Affiliation(s)
- Shaun Peter Qureshi
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Derek Jones
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Avril Dewar
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
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Boggs ZD, Regalado LE, Makary MS. Procedural Fundamentals for Medical Students: Institutional Outcomes of a Novel Multimodal Course. Acad Radiol 2022; 29:1095-1107. [PMID: 34801346 DOI: 10.1016/j.acra.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES There is a gap in current medical student education pertaining to procedural skills' exposure and acquisition. The aim of this study is to evaluate the institutional experience of a novel medical student procedural course and its impact on procedural confidence. MATERIALS AND METHODS This is a single-center prospective study performed at a public medical school and its associated tertiary care medical center between June 2020 and January 2021. This study was deemed exempt by our Institutional Review Board and was performed with participant consent. The multimodal course developed by the radiology department consisted of four didactic lectures, four simulation sessions, and a minimum of 16 clinical rotation hours with the department's vascular access team. Primary outcomes were assessed by comparing participant pre and post course surveys including twenty-five 5-point Likert scaled questions. RESULTS Twenty-five self-selected students completed the course in its entirety. The curriculum and the corresponding survey analysis were stratified into sections by procedure modality. An increase in participant confidence to a moderate or greater level was observed when comparing pre and post course survey data for each procedure: vascular access (4% vs 52%, p < 0.01), thoracentesis (8% vs 48%, p < 0.01), paracentesis (8% vs 72%, p < 0.01), lumbar puncture (4% vs 44%, p < 0.01), and bone marrow biopsy (0% vs 48%, p < 0.01). CONCLUSIONS The creation of a medical-student-centric procedural course is feasible and fills a potential gap in undergraduate medical education. This study demonstrated that a comprehensive multimodal course, designed to include didactic, simulation and clinical experiences, increases participant exposure to, participation with, and confidence in bedside procedural performance abilities.
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Affiliation(s)
- Zak D Boggs
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Luis E Regalado
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210.
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Bretagne V, Delapierre A, Cerasuolo D, Bellot A, Marcelli C, Guillois B. Randomized Controlled Study of a Training Program for Knee and Shoulder Arthrocentesis on Procedural Simulators with Assessment on Cadavers. ACR Open Rheumatol 2022; 4:312-321. [PMID: 34989181 PMCID: PMC8992473 DOI: 10.1002/acr2.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis. Methods Two groups of 15 medical students were each trained to perform a single joint arthrocentesis (“knee group” and “shoulder group”) on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered “competent on the cadaver” if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study. Results Twenty‐two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver’s knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver’s shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students’ confidence level in arthrocentesis increased significantly during the study, as did the students’ theoretical knowledge. Conclusion Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
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McGaghie WC, Adams WH, Cohen ER, Wayne DB, Barsuk JH. Psychometric Validation of Central Venous Catheter Insertion Mastery Learning Checklist Data and Decisions. Simul Healthc 2021; 16:378-385. [PMID: 33156260 DOI: 10.1097/sih.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resident physicians are expected to acquire competence at central venous catheter (CVC) insertion to a mastery standard. Valid competence decisions about resident physicians' CVC performance rely on reliable data and rigorous achievement standards. This study used data from 3 CVC simulation-based mastery learning studies involving internal medicine (IM) and emergency medicine (EM) residents to address 2 questions: What is the effectiveness of a CVC mastery learning education intervention? Are minimum passing standards (MPSs) set by faculty supported by item response theory (IRT) analyses? METHODS Pretraining and posttraining skills checklist data were drawn from 3 simulation-based mastery learning research reports about CVC internal jugular (IJ) and subclavian (SC) insertion skill acquisition. Residents were required to meet or exceed a posttest skills MPS. Generalized linear mixed effect models compared checklist performance from pre to postintervention. Minimum passing standards were determined by Angoff and Hofstee standard setting methods. Item response theory models were used for cut-score evaluation. RESULTS Internal medicine and EM residents improved significantly on every IJ and SC checklist item after mastery learning. Item response theory analyses support the IJ and SC MPSs. CONCLUSIONS Mastery learning is an effective education intervention to achieve clinical skill acquisition among IM and EM residents. Item response theory analyses reveal desirable measurement properties for the MPSs previously set by expert faculty panels. Item response theory analysis is useful for evaluating standards for mastery learning interventions. The CVC mastery learning curriculum, reliable outcome data, and high achievement standards together contribute to reaching valid decisions about the competence of resident physicians to perform the clinical procedure.
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Affiliation(s)
- William C McGaghie
- From the Departments of Medical Education (W.C.M., D.B.W., J.H.B.), Feinberg School of Medicine, Northwestern University, Chicago; and Department of Medical Education and Public Health Sciences, Loyola University Chicago Stritch School of Medicine (W.H.A.), Maywood; and Department Medicine (E.R.C., D.B.W., J.H.B.), Feinberg School of Medicine, Northwestern University, Chicago
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Warm EJ, Ahmad Y, Kinnear B, Kelleher M, Sall D, Wells A, Barach P. A Dynamic Risk Management Approach for Reducing Harm From Invasive Bedside Procedures Performed During Residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1268-1275. [PMID: 33735129 DOI: 10.1097/acm.0000000000004066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Internal medicine (IM) residents frequently perform invasive bedside procedures during residency training. Bedside procedure training in IM programs may compromise patient safety. Current evidence suggests that IM training programs rely heavily on the number of procedures completed during training as a proxy for resident competence instead of using objective postprocedure patient outcomes. The authors posit that the results of procedural training effectiveness should be reframed with outcome metrics rather than process measures alone. This article introduces the as low as reasonably achievable (ALARA) approach, which originated in the nuclear industry to increase safety margins, to help assess and reduce bedside procedural risks. Training program directors are encouraged to use ALARA calculations to define the risk trade-offs inherent in current procedural training and assess how best to reliably improve patient outcomes. The authors describe 5 options to consider: training all residents in bedside procedures, training only select residents in bedside procedures, training no residents in bedside procedures, deploying 24-hour procedure teams supervised by IM faculty, and deploying 24-hour procedure teams supervised by non-IM faculty. The authors explore how quality improvement approaches using process maps, fishbone diagrams, failure mode effects and analyses, and risk matrices can be effectively implemented to assess training resources, choices, and aims. Future research should address the drivers behind developing optimal training programs that support independent practice, correlations with patient outcomes, and methods that enable faculty to justify their supervisory decisions while adhering to ALARA risk management standards.
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Affiliation(s)
- Eric J Warm
- E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Yousef Ahmad
- Y. Ahmad is an internal medicine resident, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Benjamin Kinnear
- B. Kinnear is associate professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Matthew Kelleher
- M. Kelleher is assistant professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dana Sall
- D. Sall is assistant professor of medicine, University of Arizona College of Medicine Phoenix, and program director, HonorHealth Scottsdale Thompson Peak Internal Medicine Residency Program, Scottsdale, Arizona
| | - Andrew Wells
- A. Wells is a cardiology fellow, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul Barach
- P. Barach is clinical professor, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, and lecturer, Jefferson College of Population Health, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7906-698X
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Reeder C, McClerking C, King TS, Browning K. Improving Bedside Procedures Through the Implementation of Case-Based Simulation and Mastery Learning for Lumbar Puncture Training in Novice Advanced Practice Providers. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cunningham KB, Rogowsky RH, Carstairs SA, Sullivan F, Ozakinci G. Methods of connecting primary care patients with community-based physical activity opportunities: A realist scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1169-1199. [PMID: 33075180 DOI: 10.1111/hsc.13186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Deemed a global public health problem by the World Health Organization, physical inactivity is estimated to be responsible for one in six deaths in the United Kingdom (UK) and to cost the nation's economy £7.4 billion per year. A response to the problem receiving increasing attention is connecting primary care patients with community-based physical activity opportunities. We aimed to explore what is known about the effectiveness of different methods of connecting primary care patients with community-based physical activity opportunities in the United Kingdom by answering three research questions: 1) What methods of connection from primary care to community-based physical activity opportunities have been evaluated?; 2) What processes of physical activity promotion incorporating such methods of connection are (or are not) effective or acceptable, for whom, to what extent and under what circumstances; 3) How and why are (or are not) those processes effective or acceptable? We conducted a realist scoping review in which we searched Cochrane, Medline, PsycNET, Google Advanced Search, National Health Service (NHS) Evidence and NHS Health Scotland from inception until August 2020. We identified that five methods of connection from primary care to community-based physical activity opportunities had been evaluated. These were embedded in 15 processes of physical activity promotion, involving patient identification and behaviour change strategy delivery, as well as connection. In the contexts in which they were implemented, four of those processes had strong positive findings, three had moderately positive findings and eight had negative findings. The underlying theories of change were highly supported for three processes, supported to an extent for four and refuted for eight processes. Comparisons of the processes and their theories of change revealed several indications helpful for future development of effective processes. Our review also highlighted the limited evidence base in the area and the resulting need for well-designed theory-based evaluations.
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Affiliation(s)
- Kathryn B Cunningham
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Rayna H Rogowsky
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Sharon A Carstairs
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Frank Sullivan
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Gozde Ozakinci
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Maggio LA, Larsen K, Thomas A, Costello JA, Artino AR. Scoping reviews in medical education: A scoping review. MEDICAL EDUCATION 2021; 55:689-700. [PMID: 33300124 PMCID: PMC8247025 DOI: 10.1111/medu.14431] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. METHOD The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. RESULTS One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. CONCLUSIONS Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.
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Affiliation(s)
- Lauren A. Maggio
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Kelsey Larsen
- Department of Politics, Security, and International AffairsUniversity of Central FloridaOrlandoFLUSA
| | - Aliki Thomas
- School of Physical and Occupational TherapyInstitute of Health Sciences EducationFaculty of MedicineMcGill UniversityMontrealQCCanada
| | | | - Anthony R. Artino
- Department of Health, Human Function, and Rehabilitation SciencesThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
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15
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Cool JA, Huang GC. Procedural Competency Among Hospitalists: A Literature Review and Future Considerations. J Hosp Med 2021; 16:230-235. [PMID: 33734979 DOI: 10.12788/jhm.3590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience. METHODS We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures. RESULTS Our synthesis of the literature characterizes contributors to hospitalists' procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists. CONCLUSION We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.
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Affiliation(s)
- Joséphine A Cool
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Grace C Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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16
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Maggio LA, Costello JA, Norton C, Driessen EW, Artino AR. Knowledge syntheses in medical education: A bibliometric analysis. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:79-87. [PMID: 33090330 PMCID: PMC7580500 DOI: 10.1007/s40037-020-00626-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 05/04/2023]
Abstract
PURPOSE This bibliometric analysis maps the landscape of knowledge syntheses in medical education. It provides scholars with a roadmap for understanding where the field has been and where it might go in the future, thereby informing research and educational practice. In particular, this analysis details the venues in which knowledge syntheses are published, the types of syntheses conducted, citation rates they produce, and altmetric attention they garner. METHOD In 2020, the authors conducted a bibliometric analysis of knowledge syntheses published in 14 core medical education journals from 1999 to 2019. To characterize the studies, metadata were extracted from PubMed, Web of Science, Altmetrics Explorer, and Unpaywall. RESULTS The authors analyzed 963 knowledge syntheses representing 3.1% of the total articles published (n = 30,597). On average, 45.9 knowledge syntheses were published annually (SD = 35.85, median = 33), and there was an overall 2620% increase in the number of knowledge syntheses published from 1999 to 2019. The journals each published, on average, a total of 68.8 knowledge syntheses (SD = 67.2, median = 41) with Medical Education publishing the most (n = 189; 19%). Twenty-one types of knowledge synthesis were identified, the most prevalent being systematic reviews (n = 341; 35.4%) and scoping reviews (n = 88; 9.1%). Knowledge syntheses were cited an average of 53.80 times (SD = 107.12, median = 19) and received a mean Altmetric Attention Score of 14.12 (SD = 37.59, median = 6). CONCLUSIONS There has been considerable growth in knowledge syntheses in medical education over the past 20 years, contributing to medical education's evidence base. Beyond this increase in volume, researchers have introduced methodological diversity in these publications, and the community has taken to social media to share knowledge syntheses. Implications for the field, including the impact of synthesis types and their relationship to knowledge translation, are discussed.
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Affiliation(s)
- Lauren A Maggio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Joseph A Costello
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Candace Norton
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Erik W Driessen
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anthony R Artino
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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Sattler LA, Schuety C, Nau M, Foster DV, Hunninghake J, Sjulin T, Boster J. Simulation-Based Medical Education Improves Procedural Confidence in Core Invasive Procedures for Military Internal Medicine Residents. Cureus 2020; 12:e11998. [PMID: 33437553 PMCID: PMC7793434 DOI: 10.7759/cureus.11998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction The American Board of Internal Medicine (ABIM) requires that trainees receive procedural training for certification; however, Internal Medicine (IM) residents perform a variable number of procedures throughout residency training. This results in differences in confidence levels as well as procedural competence. For active-duty military trainees, this is especially problematic, as these procedural skills are often required during deployment soon after residency graduation. This deficit can be improved through standardized simulation-based training. Methods All internal medicine residents at our institution were invited to participate in a standardized simulation-based training program for core internal medicine procedures (lumbar puncture, arterial line, central line, thoracentesis, paracentesis, and arthrocentesis). Residents were asked to qualitatively rate their perceived procedural confidence using a Likert scale ranging from 1 (not at all confident) to 5 (extremely confident) in their ability to independently perform core internal medicine procedures prior to the simulation exercise. Experienced senior residents and internal medicine faculty instructed and supervised each resident as they performed the procedures. Following the simulation exercise, the residents repeated the survey and were asked to report whether or not they found the exercise useful. Results Of the 96 residents invited to participate, 49 completed the pre-simulation questionnaire and 36 completed the post-simulation questionnaire. The cumulative mean Likert scale confidence rating for all procedures showed a statistically significant improvement post-simulation as compared to pre-simulation, including lumbar puncture (2.45±1.1 vs. 3.42±0.87, p<0.05), arterial line (2.48±1.06 vs. 3.39±1.04, p < 0.05), central line (2.86±1.08 vs. 3.5±1.02, p < 0.05), thoracentesis (2.67±1.10 vs. 3.64±0.83, p < 0.05), paracentesis (3.1±1.08 vs. 3.82±0.74, p < 0.05), and arthrocentesis (2.56±1.07 vs. 3.67±0.80, p < 0.05). All (36/36) trainees reported that they perceived the simulation exercise as valuable. Conclusion Internal medicine residents across all post-graduate year (PGY) levels at our institution lacked confidence to independently perform core internal medicine procedures. Utilizing simulation-based medical education as an adjunct to clinical training is well accepted by internal medicine trainees, and resulted in significantly improved procedural confidence. This intervention was well received by trainees and could feasibly be replicated at other active-duty military internal medicine residency programs to assist with readiness. Research is currently in progress to correlate in-situ competency and evaluate clinical outcomes of this improved confidence.
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Affiliation(s)
- Lauren A Sattler
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Chad Schuety
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Mark Nau
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, USA
| | - Daniel V Foster
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - John Hunninghake
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Tyson Sjulin
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Joshua Boster
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
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Brydges R, Tran J, Goffi A, Lee C, Miller D, Mylopoulos M. Resident learning trajectories in the workplace: A self-regulated learning analysis. MEDICAL EDUCATION 2020; 54:1120-1128. [PMID: 32614455 DOI: 10.1111/medu.14288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units? METHODS In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts. RESULTS We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members. CONCLUSIONS We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.
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Affiliation(s)
- Ryan Brydges
- Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Judy Tran
- Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Alberto Goffi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Critical Care Medicine, Unity Health Toronto, Toronto, ON, Canada
| | - Christie Lee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Critical Care Medicine, Sinai Health System, Toronto, ON, Canada
| | - Daniel Miller
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Maria Mylopoulos
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Okusanya O, Bartow A, Aranda-Michel E, Kinnunen A, Schuchert M, Kilic A, Sanchez P, Dhupar R, Luketich J, Sultan I. Resident perception of standardization and credentialing for high-risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study. J Card Surg 2020; 35:2902-2907. [PMID: 32906194 DOI: 10.1111/jocs.15007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. METHODS The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre- and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents' perceptions of the course and the procedures. RESULTS Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledge-based evaluations. CONCLUSION Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.
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Affiliation(s)
- Olugbenga Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexandrea Bartow
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Angela Kinnunen
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kelm DJ, Ridgeway JL, Ratelle JT, Sawatsky AP, Halvorsen AJ, Niven AS, Brady A, Hayes MM, McSparron JI, Ramar K, Beckman TJ. Characteristics of Effective Teachers of Invasive Bedside Procedures: A Multi-institutional Qualitative Study. Chest 2020; 158:2047-2057. [PMID: 32428512 DOI: 10.1016/j.chest.2020.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Faculty supervision of invasive bedside procedures (IBPs) in the ICU may enhance procedural education and ensure patient safety. However, there is limited research on teaching effectiveness in the ICU, and there are no best teaching practices regarding the supervision of IBPs. RESEARCH QUESTION We conducted a multi-institutional qualitative study of pulmonary and critical care medicine faculty and fellows to better understand characteristics of effective IBP teachers. STUDY DESIGN AND METHODS Separate focus groups (FGs) were conducted with fellows and faculty at four large academic institutions that were geographically distributed across the United States. FGs were facilitated by a trained investigator, audio-recorded, and transcribed verbatim for analysis. Themes were identified inductively and compared with constructs from social and situated learning theories. Data were analyzed between and across professional groups. Qualitative research software (NVivo; QSR International) was used to facilitate data organization and create an audit trail of the analysis. A multidisciplinary research team was engaged to minimize interpretive bias. RESULTS Thirty-three faculty and 30 fellows participated. Inductive analysis revealed three categories of themes among successful IBP teachers: traits, behaviors, and context. Traits included calm demeanor, trust, procedural competence, and effective communication. Behaviors included leading preprocedure huddles to assess learners' experiences and define expectations; debriefing to provide feedback; and allowing appropriate autonomy. Context included learning climate, levels of distraction, patient acuity, and institutional culture. INTERPRETATION We identified specific traits and behaviors of effective IBP teachers that intersect with the practice environment, which highlights the challenge of teaching IBPs. Notably, FG participants emphasized interpersonal, more than technical, aspects of successful IBP teachers. These findings should inform future curricula on teaching IBPs in the ICU, standardize IBP teaching for pulmonary and critical care medicine fellows, and reduce patient injury from procedural complications.
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Affiliation(s)
- Diana J Kelm
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - John T Ratelle
- Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Adam P Sawatsky
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Andrew J Halvorsen
- Office of Educational Innovations, Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alexander S Niven
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Anna Brady
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jakob I McSparron
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Kannan Ramar
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Thomas J Beckman
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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21
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Fortuna RJ, Marston B, Messing S, Wagoner G, Pulcino TL, Bingemann T, Caiola E, Scofield S, Nead K, Robbins BW. Ambulatory Training Program to Expand Procedural Skills in Primary Care. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519859298. [PMID: 31309160 PMCID: PMC6607565 DOI: 10.1177/2382120519859298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/31/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. METHODS A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. RESULTS Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P < .0001) and faculty physicians (61.5 to 94.8; P < .0001). Similarly, mean comfort with performing procedures increased for both resident (32.1 to 62.3; P < .0001) and faculty physicians (42.2 to 85.4; P < .0001). Residents' comfort level performing procedures increased for all individual procedures measured. The mean number of procedures performed per year increased for resident (1.9 to 8.2; P < .0001) and faculty physicians (14.7 to 25.2; P = .087). CONCLUSIONS A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.
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Affiliation(s)
- Robert J. Fortuna
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Bethany Marston
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
- Department of Internal Medicine,
Allergy/Immunology and Rheumatology, University of Rochester Medical Center,
Rochester, NY, USA
| | - Susan Messing
- Department of Biostatistics and
Computational Biology, University of Rochester Medical Center, Rochester, NY,
USA
| | - Gunnar Wagoner
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Tiffany L. Pulcino
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Todd Bingemann
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Enrico Caiola
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Steven Scofield
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Karen Nead
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Brett W Robbins
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
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Gisondi MA, Regan L, Branzetti J, Hopson LR. More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:699-704. [PMID: 29166352 DOI: 10.1097/acm.0000000000002062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.
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Affiliation(s)
- Michael A Gisondi
- M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-6800-3932. L. Regan is associate professor, vice chair of education, and residency director, Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; ORCID: http://orcid.org/0000-0003-0390-4243. J. Branzetti is assistant professor and residency director, Department of Emergency Medicine, New York University School of Medicine, New York, New York; ORCID: http://orcid.org/0000-0002-2397-0566. L.R. Hopson is associate professor and residency director, Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0003-1745-0836
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23
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Hilty DM, Turvey C, Hwang T. Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education. Curr Psychiatry Rep 2018. [PMID: 29527637 DOI: 10.1007/s11920-018-0878-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Psychiatric practice continues to evolve and play an important role in patients' lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player-in delivery, lifelong learning, and education/training. RECENT FINDINGS The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice. Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.
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Affiliation(s)
- Donald M Hilty
- Mental Health and UC Davis Department of Psychiatry & Behavioral Sciences, Northern California VA Healthcare System, 10535 Hospital Way, Mather, Sacramento, CA, 95655, USA.
| | - Carolyn Turvey
- Department of Psychiatry, University of Iowa and Iowa City VA Health Care, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Tiffany Hwang
- UCSD Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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