Non-technical skills curriculum incorporating simulation-based training improves performance in colonoscopy among novice endoscopists: Randomized controlled trial.

BACKGROUND AND AIMS: Non-technical skills (NTS), involving cognitive, social and interpersonal skills that complement technical skills, are important for the completion of safe and efficient procedures. We investigated the impact of a simulation-based curriculum with dedicated NTS training on novice endoscopists' performance of clinical colonoscopies. METHODS: A single-blinded randomized controlled trial was conducted at a single center. Novice endoscopists were randomized to a control curriculum or a NTS curriculum. The control curriculum involved a didactic session, virtual reality (VR) simulator colonoscopy training, and integrated scenario practice using a VR simulator, a standardized patient, and endoscopy nurse. Feedback and training were provided by experienced endoscopists. The NTS curriculum group received similar training that included a small-group session on NTS, feedback targeting NTS, and access to a self-reflective NTS checklist. The primary outcome was performance during two clinical colonoscopies, assessed using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) tool. RESULTS: Thirty-nine participants completed the study. The NTS group (n = 21) had superior clinical performance during their first (P < 0.001) and second clinical colonoscopies (P < .0.001), compared to the control group (n = 18). The NTS group performed significantly better on the VR simulator (P < 0.05) and in the integrated scenario (P < 0.05). CONCLUSION: Our findings demonstrate that dedicated NTS training led to improved performance of clinical colonoscopies among novices.

Muslim women having abortions in Canada: attitudes, beliefs, and experiences.

OBJECTIVE: To improve understanding of the attitudes, beliefs, and experiences of Muslim patients presenting for abortion. DESIGN: Exploratory study in which participants completed questionnaires about their attitudes, beliefs, and experiences. SETTING: Two urban, free-standing abortion clinics. PARTICIPANTS: Fifty-three self-identified Muslim patients presenting for abortion. MAIN OUTCOME MEASURES: Women's background, beliefs, and attitudes toward their religion and toward abortion; levels of anxiety, depression, and guilt, scored on a scale of 0 to 10; and degree of pro-choice or antichoice attitude toward abortion, assessed by having respondents identify under which circumstances a woman should be able to have an abortion. RESULTS: The 53 women in this study were a diverse group, aged 17 to 47 years, born in 17 different countries, with a range of beliefs and attitudes toward abortion. As found in previous studies, women who were less pro-choice (identified fewer acceptable reasons to have an abortion) had higher anxiety and guilt scores than more pro-choice women did: 6.9 versus 4.9 (P = .01) and 6.9 versus 3.6 (P = .004), respectively. Women who said they strongly agreed that abortion was against Islamic principles also had higher anxiety and guilt scores: 9.3 versus 5.9 (P = .03) and 9.5 versus 5.3 (P = .03), respectively. CONCLUSION: Canadian Muslim women presenting for abortion come from many countries and schools of Islam. The group of Muslim women that we surveyed was so diverse that no generalizations can be made about them. Their attitudes toward abortion ranged from being completely prochoice to believing abortion is wrong unless it is done to save a woman's life. Many said they found their religion to be a source of comfort as well as a source of guilt, turning to prayer and meditation to cope with their feelings about the abortion. It is important that physicians caring for Muslim women understand that their patients come from a variety of backgrounds and can have widely differing beliefs. It might be helpful to be aware that patients who hold more anti-choice beliefs are likely to experience more anxiety and guilt related to their abortion than prochoice patients do.

Successful Coronary Angiography Following Rapid Intravenous Desensitization for Refractory Contrast Allergy.

Most allergic reactions to radiocontrast media can be managed with a pretreatment protocol of steroids and antihistamines. However, in rare circumstances, patients can have severe allergic symptoms despite pretreatment. In this case, we highlight the use of a novel desensitization protocol in a patient with a severe breakthrough contrast allergy and unstable angina that allowed for successful percutaneous coronary intervention. The protocol was well tolerated, feasible, and might allow other patients with similar allergies to undergo angiography and imaging studies successfully that require the use of radiocontrast media.