An Ophthalmology Virtual Externship during the COVID-19 Pandemic: A Pilot Study

Background  The evolution of medical school curricula, characterized by truncated preclinical periods and reduced emphasis on ophthalmology, presents formidable obstacles to early exposure for aspiring medical students. The constraints imposed by the coronavirus disease 2019 pandemic further exacerbated the limitations on opportunities, compelling the implementation of innovative initiatives aimed at augmenting students' ophthalmology education through virtual means. Purpose  This article assesses the impact of an Ophthalmology Virtual Externship (OVE) on medical students' knowledge, interest, confidence, and seeking mentorship in ophthalmology. Materials and Methods  A total of 76 students voluntarily participated in the program. The OVE encompassed four virtual sessions, facilitated by 4th year medical students employing a near-peer mentorship framework. The initiative was tailored for 2nd and 3rd year medical students and was conducted under the supervision of a faculty member. All participating students completed both pre- and postexternship surveys utilizing a 7-point Likert scale to gauge their levels of interest, confidence, and inclination toward mentorship opportunities in the field of ophthalmology. Furthermore, assessments of ophthalmology knowledge were administered prior to and subsequent to the externship participation. The degree of satisfaction derived from the OVE experience was also evaluated. Results  Participation in the OVE significantly elevated confidence in knowledge ( p  < 0.001) and mentorship interest ( p  = 0.029). Ophthalmology knowledge test scores also notably improved post-OVE across all participants, irrespective of prior experience ( p  < 0.001), with the most significant increase observed among 2nd and 3rd year students ( p  < 0.0001). After OVE participation, 73% of students expressed intent to pursue ophthalmology opportunities, including mentorship or research. The OVE received an average Likert score of 6.35 out of 7 for student satisfaction. Conclusion  The OVE serves as a virtual learning instrument beneficial for 2nd and 3rd year students with a proclivity for ophthalmology, offering a means to circumvent curriculum-related constraints. Moreover, given the decline in formal ophthalmic education, our study contributes to future research assessing the effectiveness of an OVE in addressing ophthalmic knowledge gaps among all medical students.

Autosensitization Triggered by Neosporin Use: A Unique Phenomenon

Interface dermatitis is a type of dermatological insult to the dermo-epidermal skin junction. When this reaction causes secondary dermatosis that occurs distally on the body, it is known as autosensitization or autoeczematization. Here, we present the case of a middle-aged gentleman, with a medical history including human immunodeficiency virus, non-adherent to highly active antiretroviral therapy, initially presenting due to chronic recurring cellulitis on the left lower leg that had become progressively erythematous and tender to palpation. A few days later, he developed an intensely pruritic, papular rash on his face and chest. Following further investigation, he reported using Neosporin ointment on the leg rash prior to admission which had then caused allergic contact dermatitis. Ultimately, the patient was diagnosed with acute interface dermatitis due to Neosporin use, which led to a secondary autosensitization reaction involving his head, neck, and arms. This case illustrates the importance of thorough history taking and clinical suspicion to appropriately diagnose this phenomenon, further demonstrating the temporal association between allergic contact dermatitis and autosensitization.

Do bedside whiteboards enhance communication in hospitals? An exploratory multimethod study of patient and nurse perspectives

OBJECTIVE

To understand patient and nurse views on usability, design, content, barriers and facilitators of hospital whiteboard utilisation in patient rooms.

DESIGN

Multimethods study.

SETTING

Adult medical-surgical units at a quaternary care academic centre.

PARTICIPANTS

Four hundred and thirty-eight adult patients admitted to inpatient units participated in bedside surveys. Two focus groups with a total of 13 nurses responsible for updating and maintaining the whiteboards were conducted.

RESULTS

Most survey respondents were male (55%), ≥51 years of age (69%) and admitted to the hospital ≤4 times in the past 12 months (90%). Over 95% of patients found the whiteboard helpful and 92% read the information on the whiteboard frequently. Patients stated that nurses, not doctors, were the most frequent user of whiteboards (93% vs 9.4%, p<0.001, respectively). Patients indicated that the name of the team members (95%), current date (87%), upcoming tests/procedures (80%) and goals of care (63%) were most useful. While 60% of patients were aware that they could use the whiteboard for questions/comments for providers, those with ≥5 admissions in the past 12 months were significantly more likely to be aware of this aspect (p<0.001). In focus groups, nurses reported they maintained the content on the boards and cited lack of access to clinical information and limited use by doctors as barriers. Nurses suggested creating a curriculum to orient patients to whiteboards on admission, and educational programmes for physicians to increase whiteboard utilisation.

CONCLUSION

Bedside whiteboards are highly prevalent in hospitals. Orienting patients and their families to their purpose, encouraging daily use of the medium and nurse-physician engagement around this tool may help facilitate communication and information sharing.

Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature

BACKGROUND

Although common, the impact of low-cost bedside visual tools, such as whiteboards, on patient care is unclear.

PURPOSE

To systematically review the literature and assess the influence of bedside visual tools on patient satisfaction.

DATA SOURCES

Medline, Embase, SCOPUS, Web of Science, CINAHL, and CENTRAL.

DATA EXTRACTION

Studies of adult or pediatric hospitalized patients reporting physician identification, understanding of provider roles, patient-provider communication, and satisfaction with care from the use of visual tools were included. Outcomes were categorized as positive, negative, or neutral based on survey responses for identification, communication, and satisfaction. Two reviewers screened studies, extracted data, and assessed the risk of study bias.

DATA SYNTHESIS

Sixteen studies met the inclusion criteria. Visual tools included whiteboards (n = 4), physician pictures (n = 7), whiteboard and picture (n = 1), electronic medical record-based patient portals (n = 3), and formatted notepads (n = 1). Tools improved patients' identification of providers (13/13 studies). The impact on understanding the providers' roles was largely positive (8/10 studies). Visual tools improved patient-provider communication (4/5 studies) and satisfaction (6/8 studies). In adults, satisfaction varied between positive with the use of whiteboards (2/5 studies) and neutral with pictures (1/5 studies). Satisfaction related to pictures in pediatric patients was either positive (1/3 studies) or neutral (1/3 studies). Differences in tool format (individual pictures vs handouts with pictures of all providers) and study design (randomized vs cohort) may explain variable outcomes.

CONCLUSION

The use of bedside visual tools appears to improve patient recognition of providers and patient-provider communication. Future studies that include better design and outcome assessment are necessary before widespread use can be recommended.