Advances in Medical Education and Practice最新文献

Purpose: Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation.

Patients and methods: We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05).

Results: Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training.

Conclusion: Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

Introduction: For more than a century, Hand hygiene (HH) has been known to be the most cost-effective hygienic method to minimize infection transmission and risk in healthcare settings. Even though 50% of healthcare-associated infections (HAIs) can be prevented with proper HH, globally 7 per 100 patients from acute-care hospitals in high-income countries (HIC) and 15 per 100 patients in low and middle-income countries (LMIC) acquire at least one HAI during their hospital stay. Even though medical healthcare students do not have the primary responsibility of providing patient care, it is necessary to train, assess, and monitor HH as their interaction with patients could lead to an increased number of HAIs. By conducting this global scoping review, we aim to summarize the global trends surrounding the knowledge, attitude, and practice (KAP) of medical healthcare students regarding HH, and how it affects patient safety.

Methods: We followed the five stages of Arksey and O'Malley's Scoping Review Methodology. The literature search was done in three databases, specifically, EMBASE, Web of Science, and PubMed. Original published research in credible journals in English conducted between 2012 and 2023 discussing HH amongst medical healthcare students all over the world were included.

Results: Twenty-three studies were included in the final analysis. The overall knowledge of medical students regarding HH was low, with some studies reporting scores as low as 10.1%. However, the attitude towards HH was generally positive, with mean scores ranging from 55% to 93%. Notably, nursing students and females exhibited better attitudes and self-reported HH practices. Furthermore, studies indicated that providing training on HH resulted in an increase in positive attitudes towards and improved practices of HH.

Conclusion: By focusing on training and facilitating improved HH practices, future generations of doctors and nurses can contribute to minimizing HAIs and enhancing patient safety. Standardized approaches and comprehensive data collection are crucial for implementing effective HH interventions.

Introduction: The rising demand for knowledge updates and technological innovations in China has made clinical placement teaching challenging. Reforms for innovative teaching models through pilot classes have shown to improve students' academic performance. This novel integration led to the announcement of healthcare collaboration in the Guangdong-Hong-Kong-Macao Greater Bay Area for projects within China's "Global-Innovation-Hub" zones. First Affiliated Hospital (FAH) of Sun Yat-sen University (SYSU) in Guangzhou and the Faculty of Medicine (FMD) of Macau University of Science & Technology (MUST) in Macau have developed an inaugural project for FMD/MUST medical students to perform pre-internships at FAH-SYSU. This study aimed to reflect on students' experiences with collaborative teaching and learning through medical curricular integration in the "Global-Innovation-Hub" zones designed by both institutions for developing integrated curriculum.

Methods: FMD/MUST students attended medical clerkships at FAH-SYSU using a system-integrated curriculum in China's "Global-Innovation-Hub" zones, allowing different education systems at different locations. Post-clerkship surveys ranked teaching models in conjunction with written reflections in response to post-clerkship questionnaires for all participating students. The teaching models were defined by the way supervisors' interaction with students, and written reflections in response to the post-clerkship questionnaire were descriptively and semantically analysed.

Results: The top-ranked teaching models include first "Student-led consultation under supervision in observers' chair with discussion", second "Observe consultation and discuss with the teacher in-between patients in observers' chair" and third "Student-led consultation under supervision in consultants' chair with discussion". The post-clerkship questionnaires showed positive outcomes.

Conclusion: This study demonstrates the successful delivery of collaborative teaching and learning through medical curricular integration in China's "Global-Innovation-Hub" zones. This integration enables the development of a consistent and student-preferred teaching model being introduced into clinical placement curriculum. The unique location of China's "Global-Innovation-Hub" zones in the Guangdong-Hong-Kong-Macao Greater Bay Area allows this integration to significantly improve students' clinical reasoning learning.

Introduction: Supervision is considered a collaboration between a supervisor and supervisee and includes perceptiveness, responsiveness of the supervisor, a state of rapport, and specific learning tasks that allow the individual to work towards a goal. The alliance in supervision has been identified as a key ingredient of effective supervision, regardless of the type of treatment, population, or supervision model being used. While it is known that the medical training environment hosts high rates of burnout, little research has examined the role of supervisory alliance in regard to burnout, distress, and self-esteem. This study aimed to apply previous models of supervisory alliance to medical education, and explore associations between educational alliance and trainee self-esteem, burnout, and distress.

Methods: Participants included 108 medical trainees (response rate = 81%). Medical trainees were recruited from a rural Pennsylvanian teaching hospital and asked to complete a voluntary and anonymous electronic survey. Multiple linear regression was used to examine the association between supervisory alliance and burnout and distress, while controlling for average hours worked and slept.

Results: Results suggested that supervisory alliance was associated with burnout, distress, and self-esteem among medical trainees.

Conclusion: Given the high rates of depression and burnout among medical providers, it may be helpful to understand the factors that may impact medical trainee's distress and esteem. Future longitudinal research might examine the role of the supervisory alliance over time, and whether strong mentorship and guidance may serve to protect trainees from burnout throughout training and into their career.

Objective: The second year of undergraduate medical education is a critical phase transitioning from basic medical knowledge to specialized learning, requiring strong critical thinking abilities. Pediatric diseases, with their unique characteristics, demand active critical thinking from pediatricians. This study aims to investigate and analyze the critical thinking dispositions of second-year pediatric medical students, identify influencing factors, and propose recommendations for improving teaching methods.

Methods: This cross-sectional study employed the Chinese version of the California Critical Thinking Disposition Inventory (CTDI-CV) and conducted an online survey among 240 second-year pediatric medical students at Chongqing Medical University, Chongqing, China. The study described the overall CTDI-CV scores and sub-dimension scores (mean ± standard deviation) and analyzed the distribution of critical thinking dispositions using t-tests and trend analysis.

Results: A total of 229 students (95.4%) completed the survey, with 58.95% being female. The overall mean critical thinking score was 287.96 ± 39.09, and 139 students (60.70%) exhibited positive or highly positive critical thinking dispositions. Rural students scored lower than non-rural students (t = -2.773, P = 0.0069), while only children scored higher than non-only children (t = 2.659, P = 0.0086). Higher high school academic ranking was associated with higher scores (H = 23.85, P < 0.001). Students whose parents had a bachelor's degree or higher scored significantly better (t = 2.373, P = 0.0188). Interest in pediatrics was linked to higher scores (H = 15.36, P = 0.0015). Positive correlations were found between analyticity, inquisitiveness, and self-confidence (r ≥ 0.75).

Conclusion: Second-year pediatric medical students in China generally display strong critical thinking abilities. Factors such as family background, academic performance, parental education level, and interest in pediatrics significantly influence these abilities. Pediatric educators should account for these individual differences to better enhance critical thinking development in students and improve teaching strategies accordingly.

Purpose: With increasing specialization among surgical divisions, a well-rounded education during a surgical residency is often accomplished by rotating among different subspecialties. Inclusion of specific rotations in the resident curriculum can be considered as a cost-benefit calculation balancing the value of exposure to a subspecialty versus the opportunity cost of potential learning from another rotation. We find that often these decisions are based on anecdotal feedback. Our goal is to supplement these reports with a quantifiable metric of learning achieved on the plastic surgery rotation. Our hypothesis in this prospective study was that residents would demonstrate improved performance on a post-rotation test after their 1-month rotation on plastic surgery compared to the pre-rotation test.

Methods: A question bank was developed to reflect institutional curriculum objectives and clinical scenarios commonly seen on the service. The questions were developed, validated and vetted in collaboration with medical educators and attending plastic surgeons yielding 20 questions available for use. Postgraduate year 1 residents were given a 10-question test before and after their plastic surgery rotation. A one-tailed paired t-test was used to assess improvement between the pre-rotation test and the post-rotation test.

Results: A total of 378 tests were administered with 228 (60%) pre- and post-rotation tests completed meeting inclusion criteria. Average percentage of correct answers for the pre-rotation test was 29% and 88% for the post-rotation test showing a differential improvement of 58% (p < 0.001).

Conclusion: Surgical trainee time is a limited commodity. Each clinical rotation needs proven consistent benefit for the trainees. We developed a questionnaire that documents the improvement in clinical knowledge after a one-month rotation on plastic surgery relative to before. The test results were consistent even when comparing trainees who did the rotation early versus late in the PGY-1 year. Clinical exposure reinforces and solidifies specialty learning.