PRiMER (Leawood, Kan.)最新文献

Introduction: Operating in-person instruction, residential living, and other activities at institutions of higher education (IHEs) in the context of the pandemic of severe acute respiratory syndrome-coronavirus 2 (SARS-Cov2) have posed a multitude of challenges. Identification of asymptomatic cases at IHEs is crucial, as a large reservoir of virus can potentially develop among students. Unfortunately, despite the advantages, rapid antigen tests (RATs) have variously been shown to perform poorly when used with asymptomatic individuals.

Methods: In order to address the appropriateness of RAT use in screening asymptomatic populations like those at IHEs, we conducted a rapid review of published evaluations of RATs available in the United States, where sensitivity and specificity were reported specifically from asymptomatic populations. We extracted sensitivity and specificity for asymptomatic populations reported in each article, along with location and important notes. The data are presented narratively.

Results: A total of 11 articles were included for evaluation and presentation, representing tests from four manufacturers. Sensitivity ranged from 35.8% to a high of about 71%, with caveats to the higher number about exposure. Both the low and high sensitivity rates were observed in Abbott BinaxNOW RATs. Due to heterogeneity and publishing differences, a meta-analysis was not feasible, but RAT tests in asymptomatic populations tended to identify roughly half of those identified as infected via reverse transcription-polymerase chain reaction. Specificity ranged from 97.8% to 100%.

Conclusion: The results of this rapid review indicate serious issues in misidentifying asymptomatic individuals as COVID-19 negative, when in fact they are infected and carrying the SARS-Cov2 virus.

Introduction: As the prevalence of chronic diseases increases worldwide, there is a need for educating future physicians in the use of lifestyle medicine to treat and prevent diseases. Any addition to the undergraduate medical curriculum requires a strategic educational approach with consideration for efficiency. This study aims to identify priorities for lifestyle medicine interventions in the undergraduate medical curriculum.

Methods: Third-year medical students (N=115) were surveyed on their beliefs about lifestyle medicine and their confidence in lifestyle medicine skills. The survey consisted of seven items to which students responded with how closely they agreed via a 5-point Likert scale. Descriptive statistics were reported.

Results: Most medical students entering their clinical years understand the value of lifestyle medicine in patient care (100%) and want to learn the skills and knowledge involved (98.2%). The value of lifestyle medicine counseling skills during the limited patient-doctor time was least universally acknowledged among third-year medical students (93.9%). Third-year medical students are most confident in being able to obtain a comprehensive lifestyle history (3.6±0.8) and least confident in setting clear, personalized, lifestyle change goals (3.1±0.9).

Conclusion: Future interventions to increase confidence in lifestyle medicine skills should focus on educating students on setting lifestyle change goals, personalizing prescriptions, and motivational interviewing for use in clinical care.

Introduction: Many residency programs utilize passive didactic lectures despite mixed evidence for knowledge retention. This prospective study investigated the efficacy of "relay," an active-learning technique, as measured by residents' knowledge retention and attitudes compared to traditional format.

Methods: Faculty presented lectures to four family medicine residency programs on a randomized schedule. Lectures were followed by a 15-minute question-and-answer (Q&A) session or relay session. A relay is a collaborative, question-based game. The primary outcome was knowledge retention at 3 months, comparing Q&A to relay sessions as measured by a multiple-choice assessment. Responses were only included if a given resident completed knowledge assessments for both Q&A and relay sessions, to allow for intraresident adjustments, in addition to program, training year, and lecturer/topic. Secondary outcomes included residents' self-perceived knowledge and engagement as surveyed by an ordinal scale immediately following the learning session.

Results: The primary analysis included 51 responses from 18 unique residents. The adjusted mean knowledge assessment score at 3 months was not statistically different after the relay sessions compared to Q&A (67% vs 60%, respectively; 7% difference, 95% CI: -4 to 18%, P=.20). For the secondary outcomes of learner attitudes (n=143 responses), learners reported greater engagement after the relay sessions compared to Q&A (51% vs 28% "very engaged"; overall P=.003), but self-perceived knowledge was not significantly different (overall P=.05, rounded down).

Conclusions: The relay technique did not show significant difference in 3-month knowledge retention, nor immediate self-perceived knowledge, despite greater learner self-perceived engagement.

Introduction: Interprofessional education (IPE) and collaborative practice increasingly inform accreditation standards for pharmacy and medical education, grounded in evidence of benefits to patients and learners. Optimizing models that meaningfully provide this type of practice remains a challenge. This study examines the impact of inpatient collaboration between pharmacy students and family medicine residents on perceptions of interprofessional care.

Methods: Pharmacy students and family medicine residents were invited to participate in an IPE experience during their medicine rotation, in which student-resident pairs worked collaboratively on patient care for a block rotation. We used a Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education Instrument (SPICE-2) survey instrument and included an opportunity for open comments by participants. We performed statistical analysis using paired t tests.

Results: We observed statistically significant changes (P<.05) in four of the 10 survey items for pharmacy students and two out of 10 in family medicine residents. Narrative comments provided by both students and residents were positive regarding the IPE experience.

Conclusion: This pilot provides preliminary evidence to support an IPE care model that integrates pharmacy students by pairing them with family medicine residents on an inpatient adult family medicine teaching service. Implementation of a paired-IPE model changed both professions' perception of their roles within the team and appreciation of training requirements. Larger studies could be done to further evaluate the outcomes of this and similar models.

Introduction: Although there are standardized assessments of medical students throughout medical school, the clinical experience of each student may vary widely. Currently, medical schools do not have a systematic method to ensure that students perform clinical skills during clinical clerkships. Our study used the Entrustable Professional Activities for Entering Residency (EPAs) framework to assess the ways in which medical students meaningfully participate in patient care at various clinical sites in each required clerkship and over time.

Methods: Over the 2020-2021 academic year, 170 third-year medical students were asked to report the number of times they performed EPA-1 (gather history and perform physical examination), EPA-5 (document clinical encounter), and EPA-6 (provide oral presentation of clinical encounter) at the end of each required clinical rotation (emergency medicine, internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology, psychiatry) at a single medical school. We used descriptive statistics and t tests to compare frequency of these EPAs by campus type, site type, clerkship, and time.

Results: One thousand, two hundred sixty-one surveys met inclusion criteria. Students performed EPA-5 more often at an academic medical center, and EPA-1 more frequently in the outpatient setting. Students performed EPA-1 and EPA-6 most often during emergency medicine and EPA-5 most often during internal medicine. Performance of all three EPAs increased over time.

Conclusion: This reporting system produced a robust data set that allowed for EPA performance comparisons by campus, site type, clerkship, and time. EPA performance varied by rotation, site type, clerkship, and time.