Relationship between mindfulness, stress, and performance in medical students in pediatric emergency simulations.

Objectives: Pediatric teams of emergency departments work under extreme stress, which affects high-level cognitive functions, specifically attention and memory. Therefore, the methods of stress management are being sought. Mindfulness as a process of intentionally paying attention to each moment with acceptance of each experience without judgment can potentially contribute to improving the performance of medical teams. Medical simulation is a technique that creates a situation to allow persons to experience a representation of a real event for the purpose of education. It has been shown that emergency medicine simulation may create a high physiological fidelity environment similarly to what is observed in a real emergency room. The aim of our study was to determine whether the technical and non-technical skills of medical students in the course of pediatric high fidelity simulations are related to their mindfulness and stress. Participants and methods: A total of 166 standardized simulations were conducted among students of medicine in three simulation centers of medical universities, assessing: stress sensation (subjectively and heart rate/blood pressure), technical (checklists) and non-technical skills (Ottawa scale) and mindfulness (five facet mindfulness questionnaire): ClinicalTrials.gov ID: NCT03761355. Results: The perception of stress among students was lower and more motivating if they were more mindful. Mindfulness of students correlated positively with avoiding fixation error. In the consecutive simulations the leaders' non-technical skills improved, although no change was noted in their technical skills. Conclusion: The results of our research indicate that mindfulness influence the non-technical skills and the perception of stress of medical students during pediatric emergency simulations. Further research is needed to show whether mindfulness training leads to improvement in this field.

The Relationship Between Soldier Performance on the Two-Mile Run and the 20-m Shuttle Run Test.

Background: The 20-m shuttle run test (MSRT) is a common field test used to measure aerobic fitness in controlled environments. The U.S. Army currently assesses aerobic fitness with the two-mile run (TMR), but external factors may impact test performance. The aim of this study is to examine the relationship between the Army Physical Fitness Test TMR performance and the MSRT in military personnel. Methods: A group of 531 (403 males and 128 females) active duty soldiers (age: 24.0 ± 4.1 years) performed the MSRT in an indoor facility. Heart rate was monitored for the duration of the test. Post-heart rate and age-predicted maximal heart rate were utilized to determine near-maximal performance on the MSRT. The soldiers provided their most recent Army Physical Fitness Test TMR time (min). A Pearson correlation and multiple linear regression analyses were performed to examine the relationship between TMR time (min) and MSRT score (total number of shuttles completed). The study was approved by the Human Use Review Committee at the U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts. Findings: A significant, negative correlation exists between TMR time and MSRT score (r = -0.75, p < 0.001). Sex and MSRT score significantly predicted TMR time (adjusted R2 = 0.65, standard error of estimate = 0.97, p < 0.001) with a 95% ratio limits of agreement of ±12.6%. The resulting equation is: TMR = 17.736-2.464 × (sex) - 0.050 × (MSRT) - 0.026 × (MSRT × sex) for predicted TMR time. Males equal zero, females equal one, and MSRT score is the total number of shuttles completed. Discussion: The MSRT is a strong predictor of the TMR and should be considered as a diagnostic tool when assessing aerobic fitness in active duty soldiers.

Implementation of performance metrics to assess pharmacists' activities in ambulatory care clinics.

PURPOSE: The development and implementation of performance metrics for assessing the impact of pharmacists' activities in ambulatory care clinics are described. SUMMARY: Ambulatory care clinic pharmacists within an integrated health system were surveyed to ascertain baseline practices for documenting and tracking performance metrics. Through literature review and meetings with various stakeholders, priorities for metric development were identified; measures of care quality, financial impact, and patient experience were developed. To measure the quality of care, pharmacists' interventions at five ambulatory care clinics within the health system were assessed. Correlation of pharmacist interventions with estimated cost avoidance provided a measure of financial impact. Surveys were distributed at the end of clinic visits to measure satisfaction with the patient care experience. An electronic system for metric documentation and automated tabulation of data on quality and financial impact was built. In a 12-week pilot program conducted at three clinic sites, the metrics were used to assess pharmacists' activities. A total of 764 interventions were documented (a mean of 24 accepted recommendations per pharmacist full-time equivalent each week), resulting in estimated cost avoidance of more than $40,000; survey results indicated high patient satisfaction with the services provided by pharmacists. Biweekly report auditing and solicitation of feedback guided metric refinement and further training of pharmacists. Tools and procedures were established for future metric expansion. CONCLUSION: Development and implementation of performance metrics resulted in successful capture and characterization of pharmacists' activities and their impact on patient care in three ambulatory care clinics.