Improving Communication Skill Competency in the Emergency Department through Role Play and Direct Observation

PURPOSE: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. METHODS: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. RESULTS: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the pre- and post-score difference between the training and control groups was not statistically significant. CONCLUSION: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the ED.

Three Cases of an Eshophageal Foreign Body Caused by Coin-shaped Rock Called Maeksum-seok

Generally, the occurrence of an esophageal foreign body due to a coin-like material is rare in adults. The Maeksumseok is a kind of rock that is believed to be good for health in Korean folk medicine. Thus, people use a Maeksumseok in various ways, one of which is keeping coin-shaped Maeksum-seok in the mouth. Because of this use, it is easy to swallow a Maeksum-seok coin by accident, and a swallowed Maeksum-seok coin will easily lodge in esophagus. We experienced three cases of an esophageal foreign body caused by a Maeksum-seok coin. The patients swallowed the Maeksum-seok coin accidentally while sleeping with the Maeksum-seok coin in their mouth for health reasons. The problem is that it was hard to detect the Maeksum-seok coin by using a simple radiologic study. However, the patients in these cases complained of a sustained foreign body sensation, so we used endoscopy. The foreign bodies were easily detected and removed by endoscopy in both cases.

Hyperbaric Oxygen Therapy in Decompression Sickness

BACKGROUND: Scuba diving has become increasingly popular in Korea. Medical problems are common with dives, especially decompression sickness(DCS). This study was performed to obtain an useful information of hyperbaric oxygen therapy in DCS in Korea. METHOD: We reviewed the 62 cases of Korean divers, who were diagnosed as DCS and received recompression therapy according to U.S. Navy Standard Recompression Treatment Table at Ocean and Underwater Medical Research and Training Center of ROK Navy, for 6 years from Jan. 1993 to Nov. 1998. RESULT: 1) the mean no-decompression limit excess time between type I DCS group(72.7 min.) and type II DCS group(92.8min.) showed significant difference. 2) The rate of symptoms appeared on surfacing and within 10min. after surfacing of type I and type II DCS were 41.4%and 72.7% respectively. 3) The cure late of type I and type II were 75.9%and 42.4% respectively. In type II DCS group, the cure rate of the group within 12 hour-delayed recompression treatment and the group above 12 hour-delayed treatment were 64.3%and time 26.3% respectively, and in type I DCS group, 100% and 66.7% respectively. CONCLUSION: These findings suggest that the education of safety, the strict observance of the standard decompression table, and the avoidance of excessive repeated diving are important for reducing the risk of diving related disease. And to offer proper management of DCS, there should be more multiplace hyperbaric oxygen chambers, the suitable transport system, and the specialist of diving medicine or hyperbaric medicine in Korea.