Автор неизвестен - Mededworld and amee 2013 conference connect - страница 129

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Summary of work: The course, held prior to the start of clinical rotations, consists of lectures, web-based didactic materials, small-group activities, and simulation exercises with an emphasis on experiential learning. To assess a shift in students' views, we modified a patient safety attitude survey (Carruthers et al 2009). Students completed this survey before and after the week-long patient safety course, and their responses were compared using the Wilcoxson signed ranks test. Summary of results: 118 students completed the 26-question survey at both assessment points. Overall, students' attitude shifts in the favorable direction were statistically significant on 17 of the 26 questions. In particular, students became more appreciative of the need to study patient safety as a discipline and of the notion that disciplinary actions and being more careful are not the most effective strategies for preventing medical errors. Students' views on error and near miss reporting were more resistant to our educational intervention.

Conclusions: The course led to favorable changes in students' attitudes towards patient safety; however, it appears that attitudes toward error and near miss reporting require different educational strategies to change.

Take-home messages: Evaluating course impact on attitudes, in addition to knowledge and skills, improves insight, pointing to specific areas that need improvement in the course design.

10K Short Communications: Simulation

Location: Club B, PCC


Use of a simulation-based education programme to improve individual and team performance in delivering high quality, safe care in the Post Anaesthetic Care Unit

Jennie Swift (Rotherham Foundation Trust NHS Hospital, Rotherham Simulation Suite, Moorgate Road, Rotherham S60 2UD, United Kingdom) Sarah Dawkins (Dawkins Consultancy, Rotherham, United Kingdom)

Mario Shekar (Rotherham Foundation Trust NHS Hospital, Anaesthetics, Rotherham, United Kingdom) Anil Hormis (Rotherham Foundation Trust NHS Hospital, Anaesthetics, Rotherham, United Kingdom)

Background: Political drivers, professional standards and patient-centred care emphasise the importance of quality and safety within health care [Dept of Health, 2008]. The Post Anaesthetic Care Unit (PACU), as part of Theatres, responds to variable workloads, patient complexity, and unexpected complications (sometimes life-threatening) whilst striving to ensure efficiency and throughput. An in situ simulation-based training programme was designed that aimed to enhance standards of care amongst the PACU team, whilst supporting improvements in patient outcomes and experience in the immediate postoperative period. Summary of work: The PACU simulation programme was based upon identified individual and team training needs, previous critical incidents, and national standards of care. Over the past 12 months we have provided a programme of regular training sessions. Relevant scenarios focused on postoperative problems such as respiratory and cardiac arrest, laryngospasm, anaphylaxis, acute coronary syndrome, hypovolaemic shock, and significant arrhythmias are taught. Session evaluation, use of evidence based scenarios, faculty development, 360 degree peer reviews, and audits of practice provided quality assurance for programme outcomes.

Summary of results: The programme has highlighted examples of excellent PACU practice. It also flagged individual, team based care and departmental processes where improvements could be made. Examples included the availability of equipment and staff, accessibility to key protocols, factors influencing the use of emergency calling systems, and staff training requirements in existing or new skills such as extubation and provision of high dependency care.

Conclusions: Improvements in care that can be addressed at the level of the individual, team or system, have been highlighted through the quality assured in situ simulation programme that has enhanced good practice within the PACU.

Take-home messages: In situ simulation is a feasible and flexible method to help identify and support professional development and quality improvement within the PACU setting.



Clinical Software for Medical Simulation

Duarte Sequeira (Faculty of Health Sciences - University of Beira Interior, Medical Students Committee, Rua Infante D. Henrique, Covilha 6200-506, Portugal) Luis Patrao (Faculty of Health Sciences - University of Beira Interior, LaC - Clinical Skills Lab, Covilha, Portugal) Juliana Sa (Faculty of Health Sciences - University of Beira Interior, LaC - Clinical Skills Lab, Covilha, Portugal) Ricardo Tjeng (Faculty of Health Sciences - University of Beira Interior, LaC - Clinical Skills Lab, Covilha, Portugal) Miguel Castelo-Branco (Faculty of Health Sciences -University of Beira Interior, LaC - Clinical Skills Lab, Covilha, Portugal)

Background: There is no software available for clinical management of advanced medical simulation environments.

Summary of work: LaC - Clinical Skills Lab - has developed a software that allows for real time interaction, independently of the used simulator, allowing requisition and visualization of diagnostic tests as well as recording clinical data. This platform has two interfaces: one for students, used in the simulated ward, and another for instructors in the control room. In this manner, instructors can observe in real time records made by the students and send them the results of the required diagnostic tests, from a pre-loaded results package for each scenario.

Summary of results: The introduction of this platform increases the accuracy of the simulation. Students need to manage the patient's condition and, at the same time, they are subject to the same constraints they would be in real environment, by using this software. Data for each new entry is recorded. This can be used for feedback and debriefing purposes, behavioural study and performance assessment. Conclusions: This tool facilitates the simulation with multidisciplinary teams, increasing the link between theory and practice. The possibility of giving oriented feedback to medical students has revealed itself essential.

Take-home messages: The use of electronic medical records software has a great potential to make clinical simulation more real, boosting medical students' skills.


Extending simulation 'outside the lines': Outcomes of a randomised educational trial of extended immersive simulation for senior medical students

Gary D Rogers (Griffith University, School of Medicine and Griffith Health Institute for the Development of Education and Scholarship (Health IDEAS), Gold Coast Campus, Gold Coast 4222, Australia) Harry W McConnell (Griffith University, School of Medicine, Gold Coast, Australia)

Nicole Jones de Rooy (Australian Capital Territory Health Directorate, Canberra, Australia)

Fiona Ellem (Griffith University, School of Pharmacy, Gold Coast, Australia)

Marise Lombard (Griffith University, School of Medicine, Gold Coast, Australia)

Background: Many junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported. Summary of work: Participants were randomised either to undertake two, week-long, extended simulations, several months apart (Intervention), or included workshops and seminars alone (Control) and assessed in relation to a range of outcome measures. Summary of results: 84 third year students were randomised, of whom 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.024) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P<0.0001), but no significant difference was seen in tests of knowledge or clinical reasoning. At the beginning of the second week, about nine months later, a significant difference was still seen between the arms in relation to the prescribing test (78% vs 70%, P = 0.0004). At the end of the second week, significant Intervention vs Control differences were seen on knowledge (mean score 15.0/25 vs 13.3/25 [P=0.005]), reasoning (mean score 18.5/30 vs 17.3/30 [P=0.020]), a further prescribing test (71% vs 63% [P<0.0001]) and a paediatric resuscitation scenario test (252.0 seconds to initiation of fluid resuscitation vs 339.2 seconds [P=0.049]).

Conclusions: The study has demonstrated a definite educational impact from contextualising learning activities through extended multi-method simulation, with persistence of the benefit on prescribing skills for at least nine months.

Take-home messages: Extended immersive simulation enhances medical student learning from related workshops and seminars.


Simulation for teaching respiratory emergencies

Felipe Oliveira Teixeira (Pontificia Universidade Catolica de Sao Paulo, Medicine, Praca Jose Ermirio de Moraes 290 Vergueiro, Av Juscelino K. Oliveira, 789, sl 212, Sorocaba 18030-230, Brazil)

Ronaldo DAvila (Pontificia Universidade Catolica de Sao

Paulo, Medicine, Sorocaba, Brazil)

Fernando Almeida (Pontificia Universidade Catolica de

Sao Paulo, Medicine, Sorocaba, Brazil)

Sandro Blasi Esposito (Pontificia Universidade Catolica

de Sao Paulo, Medicine, Sorocaba, Brazil)

Background: Emergencies are health problems that imply imminent risk of life or intense suffering and require immediate medical treatment. Students' skills for these situations are critical. Nowadays we can no


longer accept that certain medical procedures do not contemplate various requirements and conduct evidence-based.

Summary of work: The main objective of this study is to evaluate the contribution to the knowledge and skills development of methods that employ the use of simulation to teach respiratory emergencies. To this aim we conducted an elective course for students of 3rd year of medical school. During this course were taught practical lessons for developing skills using mannequins (robots) that simulate respiratory emergencies, including thoracentesis and intubation. There was a pre­test and post-test to assess students' knowledge gain and a questionnaire to assessment of the course. Summary of results: We observed a 40% average increase of right answers in the post-test compared to pre-test.

Conclusions: Simulation has proven to be a suitable method of teaching medical emergencies, but requires an active positioning of the medical student facing simulated situations. This methodology has benefits such as providing a safe environment to practice and error and the possibility of experiencing less frequent situations and promotes discussions and assimilations. We present results that suggest that Simulation is an appropriate method for teaching respiratory emergencies.

Take-home messages: Simulation must be considered for teaching respiratory emergencies.


A novel and integrated tutor function in the Visible Ear Simulator provides better learning compared to traditional dissection training of ORL residents

Steven A. W. Andersen (Rigshospitalet, Dept. of Otorhinolaryngology and Head & Neck Surgery, Blegdamsvej 9, Copenhagen 0 DK-2100, Denmark) Mads S0lvsten S0rensen (Rigshospitalet, Dept. of Otorhinolaryngology and Head & Neck Surgery, Copenhagen, Denmark)

Background: Temporal bone dissection is one of the key skills for the otorhinolaryngology resident in training and has traditionally been taught to residents through cadaveric temporal bone dissection. The Visible Ear Simulator is a freeware virtual temporal bone simulator with an integrated and intuitive tutorial function based on a volumetric approach that can be used to obtain these essential temporal bone skills. Summary of work: During the Danish course on "the middle ear" for residents training in otorhinolaryngology 17 participants in January 2012 and 17 participants in January 2013 performed a virtual mastoidectomy on the Visible Ear Simulator using the integrated tutorial function followed by a mastoidectomy on a cadaveric temporal bone with traditional instruction. Two expert raters did an end-product analysis of the mastoidectomies using a modified Welling Scale. Summary of results: We found a significant correlation between the virtual simulation and the dissection end-

product performance. The mean end-product score of the virtual mastoidectomies was found to be significantly higher than the dissection scores even though the participants did simulator training first. We suggest that the integrated tutor function of the simulator reduces the cognitive load of the participants and provides superior learning compared to traditional instruction.

Conclusions: The Visible Ear Simulator is a freeware virtual temporal bone simulator that offers an effective integrated and intuitive tutor function superior to traditional instruction for acquiring basic temporal bone


Take-home messages: Cognitive load reduction and a novel tutorial approach in virtual surgical simulation can help teach residents essential but complex skills.


Surface electromyogram differs significantly before and after laparoscopic training

Michal Nowakowski (Jagiellonian University, Department of Medical Education, Lazarza 16, Krakow 31-530, Poland)

Paulina Trybek (University of Silesia, Institute of Physics, Katowice, Poland)

Mateusz Rubinkiewicz (Jagiellonian University, Department of Medical Education, Krakow, Poland) Lukasz Machura (University of Silesia, Institute of Physics, Katowice, Poland)

Tomasz Cegielny (Jagiellonian University, Department of Medical Education, Krakow, Poland)

Background: Assessment of performance for complex motor tasks is challenging. Evaluation of outcomes is possible but not how the goals were achieved. Activation of neuromuscular system (NMS) measured by multichannel surface electromyography is used for assessment of complex motor tasks. During laparoscopic training even on box trainer direct supervision is the only viable option if excluding self directed learning based on learning on own mistakes of trainee. Summary of work: Surface EMG recorder (EMG USB, OTBioelettronica Torino, Italy) with especially designed array (16 circumferential electrodes) was used on 15 previously untrained volunteers. We measured at predefined spots on the neck and upper extremities during performance of predefined laparoscopic drills. sEMG signals were recorded and compared between baseline (rest), intracorporeal suturing exercise before training (T1) and after training (T2). Parameters of amplitude and frequency were analysed. Summary of results: There has been a significant difference between rest vs T1(p<0,05); rest vs T2(p<0,01), T1 vs T2 (p<0,05) for all subjects in paired and pooled analysis. In pooled analysis there was significant inter subject variability leading to large SD. Conclusions: Surface electromyogram differs significantly between trained and not trained. Algorithms should be developed to use this as feedback during training.


Take-home messages: Modern technology has potential to help in laparoscopic training.


An Invention of Umbilical Vein Catheterization model (UVC model) from discarded umbilical cords

Noppol Thadakul (Vachiraphuket Hospital Medical School, Pediatrics, 353 Yaowaraj Rd., Amphur Muang,

Phuket 83000, Thailand)

Anchisa Kitiyankul (Vachiraphuket Hospital Medical School, Fourth Year Medical Student, Phuket, Thailand)

Background: Umbilical Vein Cathetherization is an essential skill for physicians in neonatal care. Indications for UVC are neonatal resuscitation in the delivery room, intravenous fluid, transparenteral nutrition or blood exchange. This skill is limited to training as it needs to be applied to newborns only. The invention of a UVC model from discarded umbilical cords can help train medical professionals for a low cost employing real umbilical cords and a realistic approach. Summary of work: A discarded umbilical cord was received from a delivery room by a non-infected mother who gave consent for its use in medical learning. It was cut to 5-10 cm length and fixed within the neck of normal saline bottle. The held umbilical cord was then inserted into a 1,000 ml NSS bottle with 700 ml containing red dyed water. The skin of the UVC model was built from another material and with removable base of the model for cleaning purposes after use. Summary of results: The finished UVC model was used for teaching medical students, extern and intern for UVC insertion, blood exchange skill and medical students in group teaching. Using the model before and after was reported 85.6 % and 94.0% level of satisfaction in the model's structural and 85.2% and 95.2% in model's effectiveness. The cost of this UVC model was less than US$ 5 with respect to a commercial model which normally costs ca. US$ 500 - 1,000. Conclusions: The invention of UVC model was a low cost simulator which can be applied by medical students, interns or health personnel. Employing previously discarded umbilical cords together with basic materials available in every hospital, any medical school can construct this training aid model simply. Take-home messages: Every medical school can invent this UVC model for health personnel training, effectively and realistically at a very low cost.

10L Short Communications: Gender

Location: Club C, PCC


Show what you know, and deal with stress yourself: A qualitative study of Dutch medical interns' perceptions of stress and gender

Petra Verdonk (VU University Medical Center, School of Medical Sciences, Dpt. Medical Humanities, EMGO Institute of Health and Care Research, Van der Boechorststraat 7, Amsterdam 1081 BT, Netherlands) Viktoria Rantzsch (Delta Vir GmbH, Leipzig, Germany) Remko de Vries (Cormel IT Services, HRM department, Sittard, Netherlands)

Inge Houkes (Maastricht University, Faculty of Health, Medicine and Life Sciences, Social Medicine, School Caphri, Maastricht, Netherlands)

Background: Physicians face stressful working conditions, medical students already report high stress levels. Despite the influx of female medical students and physicians, medicine is still described as having a patriarchal culture. Such a culture favors aspects such as physicians' certainty and rationalism, also referred to as the 'masculine protest' against admitting to vulnerability in the face of human suffering. Gender differences in stress are reported, but not much is known about students' perceptions of gender aspects in relation to stress.

Summary of work: We explored how Dutch medical interns experience and perceive stress among themselves, their colleagues and among their supervisors, as well as how they perceive that gender plays a role. In 2010-2011, semi-structured qualitative interviews were conducted with seventeen Dutch medical interns, male and female. Interviews have been analyzed thematically.

Summary of results: Stress evolves mainly from having to prove themselves and show off competencies and motivation (Show What You know...). Interns seek own solutions for handling stress because stress is not open for discussion (... And Deal With Stress Yourself). Female students are perceived to have more stress and study harder to live up to expectations. To them, part-time work seems a way out of stress. Conclusions: The implicit message interns hear is to remain silent about insecurities and stress. Female students might face disadvantages by this culture. Take-home messages: Students who feel less able to internalize the masculine protest may benefit from a culture that embraces more collaborative styles such as open conversation about stress.



A systematic approach to integrate gender medicine issues and concepts during the planning and implementation phase of an outcome-based medical curriculum

Sabine Ludwig (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center, Chariteplatz 1, Berlin 10117, Germany)

Sabine Oertelt-Prigione (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center, Berlin, Germany) Manfred Gross (Charite - Universitatsmedizin Berlin, Audiology and Phoniatrics, Berlin, Germany) Annette Gruters-Kieslich (Charite - Universitatsmedizin Berlin, Dean of Faculty, Berlin, Germany) Harm Peters (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center, Berlin, Germany)

Background: Charite - Universitatsmedizin Berlin started to introduce a new curriculum in 2010, which has been employed to systematically integrate gender issues and concepts in an interdisciplinary, modular and outcome-based curriculum. The aim was to integrate relevant gender aspects into the 4 disease model modules of its 5th semester during the curriculum development process.

Summary of work: Prior module planning, relevant gender issues were selected according to intended medical subjects of the four modules. These are "infection", "neoplasia", "interaction of genome, metabolism and immune system" and "pain and mind as disease model". Corresponding gender-related learning objectives were prepared. The selected gender aspects were then incorporated into the curriculum through active participation in the module planning groups and close counselling of the individual course planners and module group members.

Summary of results: Important gender issues were broadly integrated into the disease model modules of the 5th semester as compulsory gender-related courses, teaching content, learning objectives and students' assessment and feedback. Gender sensitive language was implemented in all of those modules as well. Conclusions: Implementation of gender aspects into a new curriculum can effectively be achieved by a systematic approach including focused subject selection, formulation of gender learning objectives, active participation in the committees involved in curriculum design as well as close counselling of and cooperation with individual faculty members. Take-home messages: Our new study programme may serve as practice model for integration of gender medicine issues and concepts into an integrated, outcome-based curriculum.


Anamnesis and Gender - a Pilot Project for Improving Medical Training

Ulrike Nachtschatt (Innsbruck Medical University, Koordinationsstelle fur Gleichstellung, Frauenforderung,

Geschlechterforschung, Innrain 36/3, Innsbruck 6020, Austria)

Margarethe Hochleitner (Innsbruck Medical University, Women's Health Centre, Innsbruck, Austria)

Background: With the large number of students enrolled at medical universities many courses are taught with lecture-style instruction, giving only limited opportunities to directly apply and practice course contents. A pilot project worked out new innovative teaching and learning methods for anamnesis and gender. The project aimed to design on a small budget a flexible teaching method for big groups where students can use their newly acquired knowledge as realistically as possible, all learning channels are involved and knowledge input and applications are well-balanced. Summary of work: With a clinical psychologist, students drew up a gender-sensitive anamnesis questionnaire for use in clinical practice and a new, very practice-oriented teaching format that is now used to teach Gender Medicine.

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