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Direct observation of medical residents

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https://www.readbyqxmd.com/read/29900403/feedback-quality-using-an-observation-form
#1
Gary L Beck Dallaghan, Joy Higgins, Adam Reinhardt
Background: Direct observations with focused feedback are critical components for medical student education. Numerous challenges exist in providing useful comments to students during their clerkships. Students' evaluations of the clerkship indicated they were not receiving feedback from preceptors or house officers. Objective: To encourage direct observation with feedback, Structured Patient Care Observation (SPCO) forms were used to evaluate third-year medical students during patient encounters...
January 2018: Journal of Medical Education and Curricular Development
https://www.readbyqxmd.com/read/29878608/analysis-of-the-level-of-clinical-skills-of-physician-assistants-tested-with-simulated-intensive-care-patients
#2
Anneke J A H van Vught, Geert T W J van den Brink, Murielle G E C Hilkens, Jos A H van Oers
RATIONALE, AIMS, AND OBJECTIVES: Since adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU. METHOD: Physician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases...
June 2018: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29861084/no-360-induced-abortion-surgical-abortion-and-second-trimester-medical-methods
#3
Dustin Costescu, Édith Guilbert
OBJECTIVE: This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care. INTENDED USERS: Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs. TARGET POPULATION: Women with an unintended or abnormal first or second trimester pregnancy. EVIDENCE: PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications...
June 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/29858550/teaching-physical-examination-to-medical-students-on-inpatient-medicine-teams-a-prospective-mixed-methods-descriptive-study
#4
Paul A Bergl, Allison C Taylor, Jennifer Klumb, Kerrie Quirk, Martin D Muntz, Kathlyn E Fletcher
Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during the internal medicine clerkship. We conducted a prospective mixed-methods study at a single academic center. Data were gathered by a student researcher who directly observed inpatient teams over 3 months...
June 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29784634/evaluation-of-app-based-serious-gaming-as-a-training-method-in-teaching-chest-tube-insertion-to-medical-students-randomized-controlled-trial
#5
Patrick Haubruck, Felix Nickel, Julian Ober, Tilman Walker, Christian Bergdolt, Mirco Friedrich, Beat Peter Müller-Stich, Franziska Forchheim, Christian Fischer, Gerhard Schmidmaier, Michael C Tanner
BACKGROUND: The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce...
May 21, 2018: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/29784037/pre-and-post-diagnosis-costs-of-tuberculosis-to-patients-on-directly-observed-treatment-short-course-in-districts-of-southwestern-ethiopia-a-longitudinal-study
#6
Abyot Asres, Degu Jerene, Wakgari Deressa
BACKGROUND: Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. METHODS: A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment...
May 21, 2018: Journal of Health, Population, and Nutrition
https://www.readbyqxmd.com/read/29765259/shadowing-emergency-medicine-residents-by-medical-education-specialists-to-provide-feedback-on-non-medical-knowledge-based-acgme-sub-competencies
#7
Anna L Waterbrook, Karen C Spear Ellinwood, T Gail Pritchard, Karen Bertels, Ariel C Johnson, Alice Min, Lisa R Stoneking
Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29734453/female-physicians-in-maternal-fetal-medicine-a-32-year-perspective
#8
Jacquelyn Blackstone, Vanessa K Will, William F Rayburn
OBJECTIVE:  To examine trends of female physicians either pursuing fellowships or in active practice in maternal-fetal medicine (MFM). METHODS:  This observational study examined complete sets of MFM fellows and active members of the Society for Maternal-Fetal Medicine (SMFM) between 1985 and 2016. Databases from SMFM, American College of Obstetricians and Gynecologists (ACOG), and Accreditation Council for Graduate Medical Education were used. Analysis of covariance testing was used to assess interactions over time between groups...
May 7, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29719883/nursing-information-flow-in-long-term-care-facilities
#9
Quan Wei, Karen L Courtney
OBJECTIVE:  Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. METHODS:  This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29652043/-the-hardware-techniques-for-the-restoration-of-the-gait-stereotype-in-the-patients-following-total-hip-replacement-the-personalized-approach
#10
E S Koneva, K V Lyadov, T V Shapovalenko, E V Zhukova, V G Polushkin
BACKGROUND: total hip replacement has long ago become the «golden standard» for the treatment of dysplastic coxarthrosis in thousands of the patients receiving it every year. In the meantime, the analysis of the specialized literature gives evidence of the lack of a systematic and personified approach to the rehabilitation treatment. AIM: The objective of the present study was to improve medical rehabilitation of the patients following the total hip replacement and to develop the personalized programs for walking modality reconstruction taking into consideration the age and the body weight of the patients...
April 9, 2018: Voprosy Kurortologii, Fizioterapii, i Lechebnoĭ Fizicheskoĭ Kultury
https://www.readbyqxmd.com/read/29615354/improved-access-to-health-care-in-massachusetts-after-2006-massachusetts-healthcare-reform-law-is-associated-with-a-significant-decrease-in-mortality-among-vascular-surgery-patients
#11
Mohammad H Eslami, Katherine Moll Reitz, Denis V Rybin, Gheorghe Doros, Alik Farber
BACKGROUND: Access to medical care, by adequate insurance coverage, has a direct impact on outcomes for patients undergoing vascular procedures. We evaluated in-hospital mortality for patients undergoing index vascular procedures before and after the Massachusetts Healthcare Reform Law (MHRL) in 2006, which mandated insurance for all Massachusetts residents, both in Massachusetts and throughout the United States. METHODS: The National Inpatient Sample was queried to identify patients undergoing interventions for peripheral arterial disease, carotid artery stenosis, and abdominal aortic aneurysms based on International Classification of Diseases, Ninth Revision, Clinical Modification procedural and diagnostic codes...
March 31, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29609893/evaluation-of-the-characteristics-of-a-workplace-assessment-form-to-assess-entrustable-professional-activities-epas-in-an-undergraduate-surgery-core-clerkship
#12
Vernon R Curran, Diana Deacon, Henry Schulz, Katherine Stringer, Craig N Stone, Norah Duggan, Heidi Coombs-Thorne
OBJECTIVE: Entrustable Professional Activities (EPAs) are explicit, directly observable tasks requiring the demonstration of specific knowledge, skills, and behaviors that learners are expected to perform without direct supervision once they have gained sufficient competence. Undergraduate level implementation of EPAs is relatively new. We examined the characteristics of a workplace assessment form (clinic card) as part of a formative programmatic assessment process of EPAs for a core undergraduate surgery rotation...
March 30, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29607335/using-newly-deceased-patients-in-teaching-clinical-skills-its-ethical-and-educational-challenges
#13
Mahboobeh Saber, Seyed Ali Enjoo, Ali Mahboudi, Seyed Ziaadin Tabei
Introduction: The newly deceased patients have long been used in medical schools to teach clinical skills without any challenges as it helps to train skilled doctors. Nowadays, the use of moulages and simulators are common in teaching clinical skills since these tools provide the opportunity for frequent practice without any pain and injury. There are specific procedures which still require the use of cadavers. However, the increased significance of patient rights has generally challenged the practicality of using the deceased bodies for this purpose...
April 2018: Journal of Advances in Medical Education & Professionalism
https://www.readbyqxmd.com/read/29584792/risk-factors-for-unfavourable-treatment-outcome-among-new-smear-positive-pulmonary-tuberculosis-cases-in-china
#14
Y Lin, D A Enarson, J Du, R A Dlodlo, C-Y Chiang, I D Rusen
Setting: Three projects of the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB. Objectives: To assess unfavourable treatment outcomes (UTOs), including failure, died, loss to follow-up (LTFU), transferred out and unknown outcome, and to identify risk factors associated with UTOs. Design: This was a cross-sectional study using routine programme data. Results: Of 30 277 new smear-positive tuberculosis (TB) patients, 4261 (14.1%) had UTOs: 2048 (6.8%) LTFU, 1418 (4.7%) transferred out, 390 (1...
December 21, 2017: Public Health Action
https://www.readbyqxmd.com/read/29574896/resident-hesitation-in-the-operating-room-does-uncertainty-equal-incompetence
#15
Michael Ott, Alan Schwartz, Mark Goldszmidt, Georges Bordage, Lorelei Lingard
CONTEXT: In postgraduate medical programmes, the progressive development of autonomy places residents in situations in which they must cope with uncertainty. We explored the phenomenon of hesitation, triggered by uncertainty, in the context of the operating room in order to understand the social behaviours surrounding supervision and progressive autonomy. METHODS: Nine surgical residents and their supervising surgeons at a Canadian medical school were selected. Each resident-supervisor pair was observed during a surgical procedure and subsequently participated in separate post-observation, semi-structured interviews...
March 25, 2018: Medical Education
https://www.readbyqxmd.com/read/29557719/education-outcomes-in-a-duty-hour-flexibility-trial-in-internal-medicine
#16
RANDOMIZED CONTROLLED TRIAL
Sanjay V Desai, David A Asch, Lisa M Bellini, Krisda H Chaiyachati, Manqing Liu, Alice L Sternberg, James Tonascia, Alyssa M Yeager, Jeremy M Asch, Joel T Katz, Mathias Basner, David W Bates, Karl Y Bilimoria, David F Dinges, Orit Even-Shoshan, David M Shade, Jeffrey H Silber, Dylan S Small, Kevin G Volpp, Judy A Shea
BACKGROUND: Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. METHODS: We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores...
April 19, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29538103/harnessing-the-power-of-big-data-to-improve-graduate-medical-education-big-idea-or-bust
#17
Vineet M Arora
With the advent of electronic medical records (EMRs) fueling the rise of big data, the use of predictive analytics, machine learning, and artificial intelligence are touted as transformational tools to improve clinical care. While major investments are being made in using big data to transform health care delivery, little effort has been directed toward exploiting big data to improve graduate medical education (GME). Because our current system relies on faculty observations of competence, it is not unreasonable to ask whether big data in the form of clinical EMRs and other novel data sources can answer questions of importance in GME such as when is a resident ready for independent practice...
June 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29519238/glyphosate-exposure-in-pregnancy-and-shortened-gestational-length-a-prospective-indiana-birth-cohort-study
#18
S Parvez, R R Gerona, C Proctor, M Friesen, J L Ashby, J L Reiter, Z Lui, P D Winchester
BACKGROUND: Glyphosate (GLY) is the most heavily used herbicide worldwide but the extent of exposure in human pregnancy remains unknown. Its residues are found in the environment, major crops, and food items that humans, including pregnant women, consume daily. Since GLY exposure in pregnancy may also increase fetal exposure risk, we designed a birth-cohort study to determine exposure frequency, potential exposure pathways, and associations with fetal growth indicators and pregnancy length...
March 9, 2018: Environmental Health: a Global Access Science Source
https://www.readbyqxmd.com/read/29485019/role-of-hand-hygiene-ambassador-and-implementation-of-directly-observed-hand-hygiene-among-residents-in-residential-care-homes-for-the-elderly-in-hong-kong
#19
Vincent C C Cheng, Hong Chen, Shuk-Ching Wong, Jonathan H K Chen, Wing-Chun Ng, Simon Y C So, Tuen-Ching Chan, Sally C Y Wong, Pak-Leung Ho, Lona Mody, Felix H W Chan, Andrew T Y Wong, Kwok-Yung Yuen
OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE...
May 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29466559/association-of-faculty-entrustment-with-resident-autonomy-in-the-operating-room
#20
Gurjit Sandhu, Julie Thompson-Burdine, Vahagn C Nikolian, Danielle C Sutzko, Kaustubh A Prabhu, Niki Matusko, Rebecca M Minter
Importance: A critical balance is sought between faculty supervision, appropriate resident autonomy, and patient safety in the operating room. Variability in the release of supervision during surgery represents a potential safety hazard to patients. A better understanding of intraoperative faculty-resident interactions is needed to determine what factors influence entrustment. Objective: To assess faculty and resident intraoperative entrustment behaviors and to determine whether faculty behaviors drive resident entrustability in the operating room...
February 21, 2018: JAMA Surgery
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