Evaluation of N95 respirator ultraviolet decontamination and clinical reuse with quantitative fit testing.

The supply of N95 respirators has been severely strained by the coronavirus disease 2019 (COVID-19) pandemic. We used quantitative fit-testing to evaluate 16 participants and 45 respirators through up to 4 rounds of ultraviolet decontamination and clinical reuse. The mean fit-test failure rate was 29.7%, and the probability of failure increased through N95 reuse.

Assessing the use of social media in physician assistant education.

OBJECTIVES: This study aims to assess physician assistant (PA) students' experiences with social media (SM) as a part of their medical education. METHODS: The study is split into two phases: Phase 1- A cross-sectional survey emailed to all PA students at four PA school campuses to assess students' prior SM experiences (226 responses, 71.1% response rate); and Phase 2- Inclusion of SM educational resources, via Twitter, within lectures performed at two PA schools. A phase-2 survey assessed students' opinions of educational SM (50 responses, 59.5% response rate) and SM usage was tracked. RESULTS: The phase-1 survey respondents indicated that 97.3% (n=220) use social media; often used as a part of their education, 65% (n=147) informally and 2.7% (n=6) formally incorporated. Students most commonly use Facebook, YouTube, and Instagram, but rarely use Twitter. Currently using SM for medical education was significantly associated with predicting that future PA education will formally include SM [rs=.341 (r2=0.12), p=<.001], as did younger age, [rs=.137 (r2=0.02), p=0.042]. Of phase-2 survey respondents, 93.1% (27/29) of SM users felt it was a useful addition to the lectures. Significantly more views were captured when messages were sent during lectures Mean (SD), 102.64(39.7) than in the peri-lecture time period [49.5(10.6), p<0.001]. CONCLUSIONS:  Many PA students are currently using various forms of social media to augment their education. Most PA students support formal incorporation of social media into their education.  PA educators should consider using our data and methods of social media inclusion when designing curricula and while clinically precepting PA students.

Chemical Disaster Preparedness for Hospitals and Emergency Departments.

Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based decontamination of ambulatory, non-ambulatory, and at-risk patients are also reviewed. Physicians and clinicians, especially in the emergency department, must be familiar with methods of evaluating chemical exposures, identifying substances, recognizing toxidromes, ensuring appropriate personal protective equipment (PPE) use, performing decontamination, and initiating treatments for life-threatening conditions. By understanding the guidelines and resources available, clinicians will be better equipped to safely evaluate and treat chemically exposed or contaminated patients.

Implementing a Disaster Preparedness Curriculum for Medical Students.

OBJECTIVES: Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting. METHODS: Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree). RESULTS: A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5). CONCLUSIONS: Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago and has been well received by students without compromising the existing university curriculum. Integrating interdisciplinary teams and course components important to other education stakeholders may help other schools overcome obstacles to implementing disaster medicine training. Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of medical school.

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt). METHODS: Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills (compression rate, depth, hand position, release), and hands-off time (time without compressions). CPR skills were evaluated using a sensor-equipped mannequin and two blinded CPR experts observed testing of participants. RESULTS: Twenty-four participants were included: 12 never-trained and 12 currently certified in CPR. Comparing pre and post training, the never-trained group had improvements in average compression rate per minute (64.3 to 103.9, p = 0.006), compressions with correct hand position in 1 min (8.3 to 54.3, p = 0.002), and correct compression release in 1 min (21.2 to 76.3, p < 0.001). The CPR-certified group had adequate pre and post-test compression rates (>100/min), but an improved number of compressions with correct release (53.5 to 94.7, p < 0.001). Both groups had significantly reduced hands-off time after training. Achieving adequate compression depths (>50 mm) remained problematic in both groups. Comparisons made between groups indicated significant improvements in compression depth, hand position, and hands-off time in never-trained compared to CPR-certified participants. Inter-rater agreement values were also calculated between the CPR experts and sensor-equipped mannequin. CONCLUSIONS: A brief internet-based video coupled with skill practice on a homemade mannequin improved compression-only CPR skills, especially in the previously untrained participants. This training method allows for widespread compression-only CPR training with a tactile learning component, without fees or advance preparation.

Does tailoring instructional style to a medical student's self-perceived learning style improve performance when teaching intravenous catheter placement? A randomized controlled study.

BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student's preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student's self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student's preferred learning style with the instructor's teaching style would increase the success of placing an IV catheter. METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently randomized to instructors who were trained to teach according to a specific learning format (i.e., visual, auditory). Success was gauged by: 1) the placement of an IV on the first attempt and 2) the number of attempts made until an IV line was successfully placed. RESULTS: The average number of attempts in the matched learning style group was 1.53, compared to 1.64 in the unmatched learning style group; however, results were not statistically significant. Both matched and unmatched groups achieved a similar success rate (57 and 58 %, respectively). Additionally, a comparison of success between the unmatched and matched students within each learning style modality yielded no statistical significance. CONCLUSIONS: Results suggest that providing procedural instruction that is congruent with a student's self-perceived learning style does not appear to improve outcomes when instructing students on IV catheter placement.