Medical Improvisation Training for all Medical Students: 3-Year Experience.

INTRODUCTION: Effective communication has been shown to improve patients' health outcomes. This study utilizes medical improvisation techniques to teach communication skills to an entire medical school class. METHODS: Required workshops were held for entering third-year students from 2005 to 2017. Workshop evaluations were obtained immediately following each session and at 3 months post-workshop for one cohort. RESULTS: Four hundred ninety-four medical students participated in the improvisation workshops. Over 90% of students rated the workshops as above average or excellent. Students reported a gain in insights regarding their role as a physician (≥ 90%), an improvement in their ability to demonstrate effective communication (80-87%), and a positive impact on teamwork (91-93%). At 3 months post-workshop, 84% of students reported they had used at least 1 improvisation skill on their clinical wards (50% response rate). CONCLUSIONS: This study demonstrates that medical improvisation exercises can be scaled to an entire class of medical students versus a self-selected group of students. Further, we found that students felt that it improved their communication. This study also provides new insights regarding specific improvisation exercises that are most useful for the clinical environment.

A first-year leadership programme for medical students.

BACKGROUND: The established medical hierarchy, dramatic expansion of scientific knowledge and emphasis on value-based health care means that graduating physicians need to know how to manage and lead positive change. There is a critical gap in the teaching of these skills in undergraduate medical education. METHODS: Our medical school developed a first-year medical student competency-based leadership curriculum that focused on: leading yourself; teams and teamwork; influence and communication; problem solving; and systems thinking. The course used four methods of teaching leadership: experiential learning; targeted development; reflection; and feedback. The formal curriculum included topics such as developing a leadership agenda, challenging conversations and negotiations. The informal curriculum (learning outside of the structured curriculum) included applying leadership in co-curricular and extracurricular activities (e.g. in a student-run free clinic). Students recorded leadership experiences using a novel reflective assessment tool, obtained multi-source feedback and then articulated a plan for improvement. RESULTS: Course evaluations noted that only one-third of first-year students responded that the curriculum developed skills in communication, and the ability to problem-solve, apply systems thinking and build teams. Students self-reported that they were often building, leading and managing productive teams, and applying influence and communication. The multi-source feedback assessment revealed that students, on average, were rated as competent to proficient. DISCUSSION: Creating a robust curriculum for medical students in the first year is challenging. Student reactions ranged from affirming to critical. The next steps will focus on increasing interactive teaching and on helping students understand why, where and how leadership is important.

A Student-Led National Conference on Leadership: Broadening the Medical Student Role.

This article was migrated. The article was marked as recommended. Students have traditionally held a singular role in medical education - the learner. This narrow view neglects students unique perspective and ability to shape the future of medical education. In recognizing the need for deliberate leadership skill development and networking opportunities for medical student leaders, the American Medical Association (AMA) supported the first AMA Accelerating Change in Medical Education Student-Led Conference on Leadership in Medical Education. A planning committee of 19 students from seven medical schools collaborated to develop this conference, which took place on August 4-5, 2017 at the University of Michigan, Ann Arbor. The primary goal of the conference was for students to learn about leadership skills, connect with other student leaders, feel empowered to lead change, and continue to lead from their roles as students. Attendees participated in a variety of workshops and presentations focused on developing practical leadership skills. In addition, students formed multi-institutional teams to participate on in the MedEd Impact Challenge, attempting to address issues in medical education such as leadership curriculum development, wellness, and culture change. Post-conference surveys showed an overwhelming majority of students connected with other student leaders, shared ideas, developed collaborations, and felt empowered to enact change. Looking forward, we believe that similar student-led conferences focused on broadening the medical student role would provide avenues for positive change in medical education.

A pilot study of venous duplex ultrasound parameters in healthy children.

OBJECTIVE: The spectrum of chronic venous disease (CVD) in adults is well documented, whereas there is a paucity of data published commenting on pediatric CVD. We previously identified that there is often venous reflux present in cases of pediatric lower extremity edema despite an alternative confirmed diagnosis. To further assess the clinical significance of this venous reflux, this study aimed to elicit venous parameters in healthy pediatric controls. METHODS: Healthy pediatric volunteers aged 5 to 17 years were recruited for venous reflux study. A comprehensive venous reflux study was performed with the patient standing. Vein diameter, patterns of valvular reflux, and accessory venous anatomy were examined in the deep and superficial venous systems. RESULTS: Eighteen children including 10 boys and 8 girls were studied. Five volunteers were aged 5 to 8 years, six volunteers were aged 9 to 12 years, and seven volunteers were aged 13 to 17 years. Great saphenous vein (GSV) diameter at the saphenofemoral junction significantly increased with age. Deep vein valve closure time (VCT) did not differ significantly between groups, whereas GSV VCT was significantly higher in the 9- to 12-year age group. Incidental venous insufficiency was identified in 60% of children aged 5 to 8 years (n = 3), 50% of children aged 9 to 12 years (n = 3), and 57% of children aged 13 to 17 years (n = 4). All superficial venous reflux was confined to the GSV; there were no cases of isolated deep venous reflux. Reflux was identified at multiple GSV stations in 60% of children. There was no significant difference in incompetent GSV VCT in comparing children with and without deep venous reflux. Accessory superficial veins were identified in 20% of children aged 5 to 8 years (n = 1), 50% of children aged 9 to 12 years (n = 3), and 43% of children aged 13 to 17 years (n = 3). The presence of an accessory saphenous vein was not associated with deep venous reflux in any patient, and only 29% of those with accessory saphenous venous anatomy had evidence of superficial venous (GSV) reflux. CONCLUSIONS: The GSV continues to grow in diameter through the teenage years. Incidental valvular incompetence and GSV reflux are common. The presence of accessory saphenous veins is similarly common and not associated with venous reflux. The clinical significance and natural history of this incidental venous reflux remain unclear. Future research should determine whether these changes seen in the pediatric age group lead to CVD during later years of life.

Gait Efficiency on an Uneven Surface Is Associated with Falls and Injury in Older Subjects with a Spectrum of Lower Limb Neuromuscular Function: A Prospective Study.

OBJECTIVE: The objective of this study was to determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy. DESIGN: Twenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe diabetic peripheral neuropathy walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year. RESULTS: Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared with nonfallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-r = 0.65; P = 0.012) and remained so with inclusion of other relevant variables into the model. Post hoc analysis comparing injured with noninjured fallers showed no difference in any gait parameter. CONCLUSION: SW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces.