Using structured communication to improve patient handoffs and reduce medical errors.

ABSTRACT: Communication errors during transfer of care from one clinician to another are a major cause of medical errors. In 2006, The Joint Commission made handoff communications a national patient safety goal. In 2014, the Association of American Medical Colleges included giving and receiving a report to transfer a patient's care as one of the 13 core entrustable professional activities required for entry into residency programs. Communication is the key to successful transfer of patient care from one clinician to another during shift change. A structured method of communication used by all clinicians in high-stakes healthcare settings can ensure all vital information about a patient is given to the receiving clinician.

Cardiac auscultation: Using physiologic maneuvers to further identify heart murmurs.

Auscultation of heart sounds and murmurs often is taught in a simulated environment with optimal listening conditions. Clinicians' auscultation skills can wither if they do not have contact with patients with valvular heart disease during clinical practice, or if they rely on handheld ultrasound devices or echocardiography. This article reviews heart murmurs and how to use physiologic maneuvers during the cardiac examination to assist in identifying murmurs.

A design thinking approach to evaluating interprofessional education.

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners' attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care.

Diagnosis and treatment of restless legs syndrome.

Restless legs syndrome (RLS) is a disorder characterized by an irresistible urge to move the legs during rest, usually accompanied by uncomfortable sensations in the affected extremity or extremities. RLS can manifest at any age but prevalence increases with advancing age. This article describes the symptoms of RLS, associated comorbidities, and how to diagnose and manage RLS.

Screening for Undetected Depression in Physician Assistant Students.

PURPOSE: The purpose of this article was to measure and compare depressive symptoms among physician assistant students during didactic and clinical phases. METHODS: Students (n = 123) completed the PHQ-9, and responses were scored in 2 ways (PHQ-2 and PHQ-9). First, submissions were deemed positive and assigned a severity if question 1 or 2 scored 3 or above (PHQ-2 method). Second, all submissions were summed and assigned a severity (PHQ-9 method). RESULTS: Using the PHQ-2 method, 8.13% of students screened positive; using the PHQ-9 method, 98.37% screened positive for at least minimal depression. Almost half (47.15%) of the students reported mild to severe depression. No statistically significant differences were observed in total scores between classes (P = .1849). Statistically significant differences were observed when we examined feeling tired with little energy (P = .0028) and trouble with sleeping (P = .0436). CONCLUSIONS: Implementing routine depression screening of trainees and restricting the number of clinical work hours could help combat increasing fatigue. Earlier intervention and resources for students struggling with depressive symptoms are needed.

Enhancing Physician Assistant Student Clinical Rotation Evaluations With the RIME Scoring Format: A Retrospective 3-Year Analysis.

PURPOSE: This article describes a 3-year retrospective analysis of student clinical rotation evaluations using the Reporter-Interpreter-Manager-Educator (RIME) scoring format. The intent of the analysis was to assess scoring trends to determine whether students with high scores on the Physician Assistant National Certifying Exam (PANCE) also achieved high RIME scores on clinical rotations. METHODS: The top and bottom quartiles of PANCE scores were identified for the University of Texas (UT) Southwestern Medical Center's physician assistant (PA) classes of 2010-2012 (n = 106). RIME scores for the top and bottom quartiles of students (n = 54) also were identified. RIME scores for the same cohort of students were analyzed using the top and bottom quartiles of students' PANCE scores. RESULTS: The Wilcoxon matched-pairs signed rank test revealed that students with top quartile PANCE scores received a higher aggregate RIME score of 557 compared with the lower quartile of PANCE performers' score of 520 (P < .03). Results for RIME scoring trends, PANCE scores, and end-of-rotation examination scores are presented. CONCLUSIONS: Students from the UT Southwestern Medical Center's PA classes of 2010-2012 obtained a Manager classification most often (52%), and students with higher PANCE scores also received higher RIME scores on clinical rotations.

Development, implementation, and short-term effectiveness of an interprofessional education course in a school of health professions.

It is accepted that interprofessional education (IPE) has positive benefits for health profession students, including effective communication, increased teamwork skills, and better appreciation for the roles of other health professions. However, the question remains of how to effectively deliver IPE for health professions students in an educational environment. To address this problem, the University of Texas Southwestern School of Health Professions developed an IPE course, Interdisciplinary Development, Education, and Active Learning (IDEAL), incorporating seven disciplines represented within the school. The hypothesis was that a two-semester exposure to the new curriculum and related activities would have a significant positive influence on students' understanding of the elements required for effective communication (e.g., listening and interpersonal skills), teamwork skills, and understanding the roles of other health professions. An assessment of a student's understanding of communication and teamwork skills was administered on the first and last day of the IDEAL course to test the hypothesis and determine if course objectives of improving student's communication and teamwork skills were met. Questions were divided into three focus areas of teamwork, listening, and interpersonal communication. Findings showed a significant (p < 0.016) increase in scores for all three areas, the largest being in teamwork. Also, results from an anonymous, open-ended survey of the overall IDEAL course at the end of the course showed overwhelming consensus regarding the success and effectiveness of the healthcare team grand rounds presentations from which the students learned about other professions and their roles on the healthcare team in a case-based format.

Physician assistants in emergency medicine: the impact of their role.

BACKGROUND: Emergency medicine (EM) in North America has been undergoing significant transformation since the new century. Recent health care reform has put it center stage. Access demand for acute care is increasing at the same time the number of qualified emergency physicians entering service has reached a plateau. Physician assistants (PAs), one alternative, are employed in emergency departments (EDs), but little is known about the impact of their role. OBJECTIVES: This was a literature review to identify the current role of PAs in patient treatment and the management of emergency services. METHODS: All publications and designs from 1970 through 2009 were identified using multiple science citation indices. Each author reviewed the literature, and categories were developed based on consensus. RESULTS: Thirty-five articles and reports were sorted into categories of interest: prevalence of PAs in EDs, efficiency and quality of care, patient satisfaction, rural emergency care, and legal issues. Each category is summarized and discussed. Evidence comparing the clinical effectiveness of PAs to mainstream management of emergency care was only fair in methodologic quality. CONCLUSIONS: The use of PAs in EDs is increasing, and this expansion is due to necessity in staffing and economy of scale. Unique uses of PAs include wound management, acute care transfer management to the wards, and rural health emergency staffing. While their role seems to be expanding, this assessment identified gaps in deployment research using appropriate outcome measures in the area of clinical effectiveness of PAs.

The use of course portfolios to document the scholarship of teaching.

One strategy that novice and experienced PA faculty can use to address the needs of the scholarship of teaching--particularly the institution's need to address faculty evaluation, tenure, and promotion--is to use a course portfolio. A course portfolio can be used in many other ways that are beneficial to the instructor, fellow faculty, and the PA program.