Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities.

BACKGROUND: Timely and effective bystander first aid can improve outcomes for trauma victims. Bystanders are present at most traumas and are more likely to assist with prior training. MATERIALS AND METHODS: An evidence-based course was created for the general public in high-risk Chicago neighborhoods focused on basic traumatic first aid, including scene management, hemorrhage control, and mitigating the psychological impact of trauma to overcome the bystander effect. Prospectively, participants completed knowledge-based and self-efficacy assessments precourse, postcourse, and 6 mo follow-up. The change in self-efficacy and knowledge scores was analyzed. RESULTS: Over 32 courses, 503 participants were taught; 474 and 460 participants completed precourse and postcourse surveys, respectively, whereas 60 of 327 who consented for follow-up completed the 6-mo survey. Postcourse, participants were more likely to assist trauma victims and felt more confident in the quality of care they could provide; the effect remained significant at 6 mo (all P < 0.001). All seven self-efficacy empowerment-based questions individually demonstrated improvement from precourse to postcourse (P < 0.001), with an overall mean (SD) increase of 2.8 (2.1, P < 0.001); six maintained significance at follow-up with an overall mean increase of 2.8 (1.9, P < 0.001). Knowledge scores improved from 6.2 of 10 to 7.2 postcourse and 7.7 at follow-up (P < 0.001). Most improved were the ability to render first aid and apply tourniquets. CONCLUSIONS: The TFRC increased self-efficacy, successfully teaching initial trauma care, particularly hemorrhage control and scene safety, suggesting that a grassroots approach to trauma care may improve outcomes in communities that experience high violence rates.

Nurses in medical education: A unique opportunity.

Medical students are expected to learn certain procedural skills in addition to clinical skills, such as assessment and decision making. There is much literature that shows proficiency in procedural skills translated to improved outcomes and cost-saving. Given the time constraints placed by increasing clinical demands, physicians have less time to work with students in teaching technical skills. There is a unique opportunity to utilize nurses in clinical clerkships to teach procedural skills. A dedicated nurse educator can provide a consistent curriculum, work with learners to achieve proficiency, and provide measurable outcomes. Future research should explore the role played by nurses in medical education and the comparison of instructional effectiveness.

Outcomes Associated With Insertion of Indwelling Urinary Catheters by Medical Students in the Operating Room Following Implementation of a Simulation-Based Curriculum.

PURPOSE: Catheter-associated urinary tract infection (CAUTI) is a priority quality metric for hospitals. The impact of placement of indwelling urinary catheter (IUC) by medical students on CAUTI rates is not well known. This study examined the impact of a simulation-based medical student education curriculum on CAUTI rates at an academic medical center. METHOD: Patient characteristics, procedural data, and outcome data from all operating room IUC insertions from June 2011 through December 2016 at the Northwestern University Feinberg School of Medicine were analyzed using a multivariable model to evaluate associations between CAUTI and inserting provider. Infection data before and after implementation of a simulation-based IUC competency course for medical students were compared. RESULTS: A total of 57,328 IUC insertions were recorded during the study period. Medical students inserted 12.6% (7,239) of IUCs. Medical students had the lowest overall rate of CAUTI among all providers during the study period (medical students: 0.05%, resident/fellows: 0.2%, attending physicians: 0.3%, advanced practice clinicians: 0.1%, nurses: 0.2%; P = .003). Further, medical student IUC placement was not associated with increased odds of CAUTI in multivariable analysis (odds ratio, 0.411; 95% confidence interval: 0.122, 1.382; P = .15). Implementation of a simulation-based curriculum for IUC insertion resulted in complete elimination of CAUTI in patients catheterized by medical students (0 in 3,471). CONCLUSIONS: IUC insertion can be safely performed by medical students in the operating room. Simulation-based skills curricula for medical students can be effectively implemented and achieve clinically relevant improvements in patient outcomes.

All work and no play: Addressing medical students' concerns about duty hours on the surgical clerkship.

BACKGROUND: Given the option of preferencing rotations for a 3rd year core surgery clerkship, we observed students often requested services perceived as less time-intensive. We compare self-reported duty hours with academic outcomes. METHODS: We examined duty hours from 165 third-year medical students on a surgery clerkship at a single institution for academic year 2016-2017. Partial correlations and logistic regression modeling were used to assess the number of hours medical students worked on academic outcomes. RESULTS: Medical student duty hours did not significantly correlate with the NBME Surgery Subject examination score (r = 0.08; p = 0.34), CPE score (r = 0.14; p = 0.09) or a clerkship grade of Honors (OR 0.993; CI 0.925-1.065). Prior completion of an internal medicine clerkship was correlated with a higher NBME Surgery Subject examination score (r = 0.27; p < 0.001). CONCLUSION: This analysis demonstrates duty hours on a surgical clerkship do not correlate with academic performance. These data can be used to counsel students on career planning and choosing surgical rotations based on interest and not perceived workload.

Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students.

Introduction: The operating room is a complex environment in which individual team members perform specific tasks according to their role. A simulation activity was created to introduce medical students on the surgery clerkship to issues relating to patient safety, infection control, and regulatory requirements. Methods: This activity takes place prior to general surgery rotation operative experiences, and addresses the need for students to practice roles they will perform while participating in patient care. The activity includes a simulated operation, an assessment, and a scripted debriefing. Among other tasks, students practice safe patient transfer and monitoring, donning sterile garb, preparing the surgical site, and being active participants in a sign-in and time-out. Students are assessed on assigned tasks, their ability to maintain sterility, and the degree to which they engage with their team. Results: Students reported the simulation helped them better understand how they could become involved on their first day in the operating room. Students also reported they were more confident when in the operating room. This finding also extended to students who had previously been in the operating room during a prior OB/GYN rotation. Discussion: Patient safety is paramount when in the operating room, and this simulation activity fills a current gap in student's practical knowledge as they prepare to enter their surgery clerkship. Giving medical students the information and skills needed to be safe and effective members of the operating team prior to entering the operating room is of benefit to the surgical team, students, and patients.