Medical students in the pre-hospital environment - An untapped resource for undergraduate acute care and interprofessional education.

BACKGROUND: The King's College London Pre-hospital Care Programme (KCL PCP) is a student-run programme that provides undergraduate medical students with the opportunity to attend observer shifts with the local ambulance service. This study evaluates the contribution of pre-hospital exposure to medical students' clinical and professional development. METHODS: Students were asked to complete a Likert-scale based survey on self-reported exposure and confidence in various aspects of acute patient assessment, communication and interprofessional education, both before and after the programme; additional qualitative questions querying their experience were asked post-programme. Pre and post-programme Likert-scale responses were matched and statistically analysed, alongside a thematic analysis of qualitative responses. RESULTS: Exposure to ambulance service clinicians, confidence assessing acutely unwell patients, and confidence making clinical handovers all increased with statistical significance. Key areas of learning identified from the thematic analysis include increased confidence communicating with patients and families, and an enriched understanding of the work done by pre-hospital clinicians. CONCLUSIONS: Time spent in the pre-hospital environment shadowing ambulance service clinicians positively contributes to acute care knowledge, inter-personal skills and interprofessional understanding. Rotating medical students through the pre-hospital environment could bridge education gaps in these areas in a manner that complements traditional pre-clinical and clinical teaching.

Simprovisation: A model for student-led simulation.

BACKGROUND: Simulation is well established in medical education, with scenarios designed by faculty members to elicit specific learning outcomes. We describe and evaluate a learner-led style of simulation-based education that puts learners in control of the day. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements. Participants are divided into two groups. They are asked to consider their learning needs and are provided with resources and faculty member support to write two simulation scenarios. Faculty members remain available to guide scenario writing and offer 'micro-teaching' on required topics. The groups then swap and participate in the scenarios written for them by the opposite group. Each scenario is followed by a structured debriefing, providing opportunities for participants to share their learning from the scenarios. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements METHODS: We delivered Simprovisation to 62 participants ranging from fourth-year medical students to junior doctors. We conducted pre- and post-course questionnaire surveys and invited participants to focus groups to discuss their experiences. RESULTS: Our feedback questionnaire shows 100% of 58 respondents found Simprovisation useful, and 95% were able to meet at least two out of three self-determined learning outcomes. Thematic analysis of focus group transcriptions showed that participants valued group-based work and setting their own learning objectives. They found writing simulation scenarios to be challenging, but a valuable source of learning, and reported being more engaged compared with previous simulation study days. CONCLUSIONS: Simprovisation is an innovative style of simulation-based education that allows learners to effectively define and address their own learning needs.

Improving the documentation quality of point-of-care ultrasound scans in the emergency department.

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the time-pressured environment of the emergency department (ED). A survey of 10 junior ED clinicians at the Princess Royal University Hospital (PRUH) found that total POCUS documentation was as low as 38% in some examinations.This quality improvement project aimed to increase the coverage and quality of POCUS documentation in the ED. This was done by using a plan-do-study-act (PDSA) regime to improve the quality of POCUS documentation from the original baseline to 80%. There were three discreet PDSA cycles and the interventions included improving education and training about POCUS documentation and the introduction of an original proforma, which incorporated six minimum requirements for POCUS documentation as per the joint RCEM and Royal College of Radiologists (RCR) guidelines for POCUS documentation (patient details, indications, findings, conclusions, signature and date).The project team audited the quality of all documented scans in the resuscitation department of the PRUH against the RCEM/RCR guidelines at baseline and following three discrete PDSA cycles. This was done over an 8-week period, spanning 696 attendances to the resuscitation area of the ED and 42 documented POCUS examinations.Quality recording of the six RCEM/RCR elements of POCUS documentation was poor at baseline but improved following three successful PDSA cycles. There was a demonstrated improvement in five of six documentation elements: patient details on POCUS documentation increased from 53.3% to the 66.7%, indication from 60.0% to 66.7%, conclusion from 13.0% to 83.0%, signature from 86.7% to 100.0% and date from 46.7% to 66.7%.These results suggest that the introduction of a proforma and a vigorous education strategy are effective ways to improve the quality of documentation of ED POCUS.

Acute testicular pain in children: collaboration in timely management.

Acute scrotal pain in a child is a urological emergency. Surgeons should be involved early and exclude torsion promptly, often by surgical exploration. This short report compares the time taken by different medical practitioners [Emergency Department (ED) doctors and surgeons] to assess children presenting to the ED with acute scrotal pain. A retrospective observational study was carried out in a district general hospital ED over a 2-year period. A total of 205 children presented with testicular pain, 48 of whom were clinically diagnosed with torsion in the ED. Surgeons reviewed patients with testicular pain quicker than ED doctors when they were referred directly from triage (P=0.019). Overall, review by a surgeon was more timely if the patient was referred directly from triage rather than after referral by the ED doctor (P<0.0001). A direct fast-track referral system to surgeons is needed in the ED to prevent unnecessary delays in definitive management of patients with testicular pain.

Abdominal pain with a twist.

Malrotation in children is due to either an incomplete or non-rotation of the foetal mid-gut during perinatal development. Presentation is usually in the first few weeks of life, often with life-threatening volvulus and ischaemia. However, it can be a rare cause of abdominal pain in older children and young adults. We present such a case, as a reminder to emergency physicians that malrotation should be considered in the differential diagnosis of recurrent or chronic abdominal pain not only in children but also in adolescents.