Development and Evaluation of an Inter-professional Education Course at a Medical School in Korea

Background@#Interprofessional collaborative practice (IPCP) is emphasized in medical care for patient safety. As patient care is provided by teams, interprofessional competence is required to ensure the quality and safety of care and should be taught as early as possible.In this study, we introduced a 2-week interprofessional education (IPE) curriculum and attempted to describe and evaluate its effectiveness among medical students. @*Methods@#We developed a 2-week IPE course and gave it to third- or fourth-year medical students (n = 166) from 2018 to 2019. The curriculum was composed of interactive lectures, discussions, small-group discussions, and simulation and was given to diverse medical students. Students were asked to report their satisfaction with the IPE program, write a reflection paper, and complete readiness for interprofessional learning scale (RIPLS) questionnaires before, immediately after, and 4 months after the curriculum. We also obtained 360° evaluations of the students by other health professionals 1 year after the training. @*Results@#The IPE program changed students' attitudes about interprofessional learning, from less favorable to more favorable. The 360° evaluation by nurses revealed that students became more favored as teammates (overall satisfaction with them as teammates increased from 3.1/5 to 3.4/5) compared to medical interns before IPE training, and complaints from nurses about medical interns were significantly less frequent 1 year after the training. @*Conclusion@#The IPE program was effective in preparing medical students for team based collaborative practice even though it was short and exposed once in the curriculum. Further extension to other medical schools is recommended

Content analysis of error disclosure communication of emergency medicine residents in simulation using standardized patient / 의료커뮤니케이션

Background@#: We analyze the contents of conversations of emergency medicine (EM) residents in a simulation using standardized patients in error disclosure education, and examine the characteristics of them. @*Methods@#: Error disclosure education program was conducted for 15 EM residents at a training hospital. One case of near miss and one case of adverse event were developed, and all 15 residents participated in each case. The contents of 30 error disclosure conversation were analyzed. @*Results@#: Residents talked more in ‘Acknowledge what happened’ and ‘Response/Plan for care’, and it was rare to have conversations of ‘Tell me about it’ or ‘Answer questions’ in both cases. The cause of the incident was explained frankly, but when the patient blamed there were some residents who told honestly or not. There was a tendency to vaguely reveal the subject who made the mistake or attribute it to another cause. Most of residents apologized to the patient. Most of residents explained systematic recurrence prevention measures and compensation plans, but there were cases where the contents were not specific or inaccurate. Throughout the entire phase, the expression “we” was often used. @*Conclusion@#: Residents had doctor-led conversations while error disclosure, so that they need more patient-centered conversations. When apology, empathy and regret should be conveyed in various expressions. Residents need to be properly trained and able to explain to patients about follow-up measures such as systematic recurrence prevention measures and compensation plans. These results can be a basic material for teaching error disclosure or guidelines.

Difference of Perceived Readiness for Interprofessional Learning among Medical and Nursing Students after Simulation-based Interprofessional Education / 의료커뮤니케이션

Background@#The purpose of this study was to investigate the differences of readiness for interporfessional learning before and after applying a simulation-based interprofessional education (sim-IPE) program among medical and nursing students. @*Methods@#This study used one-group pretest-posttest design. A sim-IPE program was implemented for 94 medical and 41 nursing students during half a day. The program was consisted of team building games, simulation, board games, and case discussion. The readiness for interprofessional learning scale (RIPLS) which is a 5-point Likert type and has four domains was used to assess students’ perceptions pre- and post-IPE program. Also, students were requested to write three words that immediately came to mind when they saw a word of ‘teamwork’. Data were analyzed by frequency, mean and standard deviation, paired t-test, and Cronbach’s alpha. @*Results@#A total scores of RIPLS significantly increased from 78.3 to 86.7 points after implementing a simulation-based IPE program (t=-14.80, p<.001). Among the most submitted words by students, a ranking of ‘communication’ has risen from fifth pre-IPE to second post-IPE. @*Conclusions@#Based on the results form our study, a simulation-based IPE program provides a very valuable educational opportunity for students to increase positive attitude to interprofessional learning. A variety of IPE programs should be developed and incorporated in all healthcare professional curriculums.

Development and Evaluation of an Inter-professional Education Course at a Medical School in Korea

Background@#Interprofessional collaborative practice (IPCP) is emphasized in medical care for patient safety. As patient care is provided by teams, interprofessional competence is required to ensure the quality and safety of care and should be taught as early as possible.In this study, we introduced a 2-week interprofessional education (IPE) curriculum and attempted to describe and evaluate its effectiveness among medical students. @*Methods@#We developed a 2-week IPE course and gave it to third- or fourth-year medical students (n = 166) from 2018 to 2019. The curriculum was composed of interactive lectures, discussions, small-group discussions, and simulation and was given to diverse medical students. Students were asked to report their satisfaction with the IPE program, write a reflection paper, and complete readiness for interprofessional learning scale (RIPLS) questionnaires before, immediately after, and 4 months after the curriculum. We also obtained 360° evaluations of the students by other health professionals 1 year after the training. @*Results@#The IPE program changed students' attitudes about interprofessional learning, from less favorable to more favorable. The 360° evaluation by nurses revealed that students became more favored as teammates (overall satisfaction with them as teammates increased from 3.1/5 to 3.4/5) compared to medical interns before IPE training, and complaints from nurses about medical interns were significantly less frequent 1 year after the training. @*Conclusion@#The IPE program was effective in preparing medical students for team based collaborative practice even though it was short and exposed once in the curriculum. Further extension to other medical schools is recommended

Interprofessional education for patient safety in health workers of various hospitals using active learning strategies / 의료커뮤니케이션

Background@#Patient safety has a direct impact on the patient’s health and life, so all members of the hospital should consider it first. Patient safety accidents are often occured by organizational problems rather than individual medical personnel. Therefore, effective interprofessional collaboration(IPC) among experts is essential, so interprofessional education(IPE) is considered important. @*Methods@#: A prospective study method of one-group pretest-posttest design was used that provides IPE using active learning-oriented teaching methods for health workers in various occupations of various hospitals, and evaluates self-efficacy, communication confidence, and attitude toward IPE. @*Results@#: 17 trainees from 8 hospitals were evaluated. First, the average of the awareness of patient safety culture was 3.62 points. Next, the score of each indicators increased in the pre-post evaluation. The average of communication confidence was from 3.73 to 3.95 points, self-efficacy was from 3.99 to 4.11 points, and attitude toward IPE was from 4.44 to 4.52 points, but not significant. @*Conclusions@#This study would have a great significance in that it was conducted on health workers in various occupations of various hospitals. As a result of a pre and post education survey conducted with trainees, the score was improved in communication confidence, self-efficacy, and attitude toward IPE. It seems to be due to the use of active learning teaching methods, and the active participation of trainees.

The learner-adjusted assessment tool for endotracheal intubation considering examiners' different expectations of competence

OBJECTIVE: Endotracheal intubation (ETI) is the most reliable way to manage the airway. Stepwise deliberate practice and mastery training is essential in maintaining and promoting the skill of intubation. This study was conducted to identify differences in examiners' expectations regarding competent skill performance and to develop learner-adjusted assessment tools with appropriate levels according to student and resident learners based on the expectations and limited observation of performance by examiners. METHODS: This was an exploratory, psychometric study using a simple airway part task trainer. The draft ETI assessment tool from the literatures, previous tools, and the preliminary learner-adjusted assessment tool for students and residents were developed and analyzed. Knowledge-based and competence-based items for each learner group were identified based on experts' expectations. The final learner-adjusted tools were refined through analyzing the content validity, internal consistency, and interrater reliability based on assessing the observed performance of 14 students and 12 residents by ten experts. RESULTS: The preliminary student-adjusted assessment tool and resident-adjusted assessment tool had 12 items on the checklist with a ternary scoring system and a ternary scoring checklist including 15 items, and an overall Global Rating Scale. The final student-adjusted assessment tool was composed of a ternary scoring checklist including 9 items (total CVI, 86.6%; Cronbach's α, 0.83; interrater reliability, 0.64). The resident-adjusted assessment, on the other hand, was also composed of a ternary scoring checklist including 12 items (total CVI, 86.4%; Cronbach's α, 0.7; interrater reliability, 0.78), in addition to global rating scale including ‘rating of the overall process’. CONCLUSION: The experts had different expectations regarding the level of competence in each step according to learner groups with different levels of difficulty. Understanding the factors influencing assessments can provide a guide for teaching and objectively assessing to the examiner.

Which Fingers Should We Perform Two-Finger Chest Compression Technique with When Performing Cardiopulmonary Resuscitation on an Infant in Cardiac Arrest?

This study compared the effectiveness two-finger chest compression technique (TFCC) performed using the right vs. left hand and the index-middle vs. middle-ring fingers. Four different finger/hand combinations were tested randomly in 30 healthcare providers performing TFCC (Test 1: the right index-middle fingers; Test 2: the left index-middle fingers; Test 3: the right middle-ring fingers; Test 4: the left middle-ring fingers) using two cross-over trials. The "patient" was a 3-month-old-infant-sized manikin. Each experiment consisted of cardiopulmonary resuscitation (CPR) consisting of 2 minutes of 30:2 compression: ventilation performed by one rescuer on a manikin lying on the floor as if in cardiac arrest. Ventilations were performed using the mouth-to-mouth method. Compression and ventilation data were collected during the tests. The mean compression depth (MCD) was significantly greater in TFCC performed with the index-middle fingers than with the middle-ring fingers regardless of the hand (95% confidence intervals; right hand: 37.8-40.2 vs. 35.2-38.6 mm, P = 0.002; left hand: 36.9-39.2 vs. 35.5-38.1 mm, P = 0.003). A deeper MCD was achieved with the index-middle fingers of the right versus the left hand (P = 0.004). The ratio of sufficiently deep compressions showed the same patterns. There were no significant differences in the other data. The best performance of TFCC in simulated 30:2 compression: ventilation CPR performed by one rescuer on an infant in cardiac arrest lying on the floor was obtained using the index-middle fingers of the right hand. Clinical Trial Registry at the Clinical Research Information Service (KCT0001515).

Investigation of Emergency Department Violence: Resident Survey

PURPOSE: The Korean Intern Resident Association and Korean Society of Emergency Medicine announced the 'Hospital violence response system' to secure patient safety and provide a health care provider countermeasures against hospital violence. The aim of this study is to investigate the response to hospital violence in the ER and which measures could improve the current status. METHODS: Emergency medicine residents in the Seoul, Incheon, Kyung-gi area participated in the survey. The questionnaire included 4 categories (1. Awareness of protocol, 2. Experience and countermeasure for hospital violence, 3. Understanding of protocol, 4. Suggestions to improve against hospital violence) RESULTS: Among 362 candidates, 236 (65.2%) participated in the survey. Only 7.6% of residents have not experienced hospital violence. In the group of people who were aware of the protocol, participants tended to be more familiar with processes of the hospital violence response protocol, and willing to deal with violence using a better systematic support. People did not counteract to hospital violence because the process was thought to be too complicated. Only 63 participants were actively involved in an official course for countermeasure. Participants suggested that police should deal more appropriately with hospital violence. CONCLUSION: The hospital violence response protocol is thought to have a positive effect on appropriate management of hospital violence. However, a multi-disciplinary approach to hospital violence from the hospital, police, and judicial authority should be developed.

Changes of One-handed Chest Compression Qualities According to Rescuer Fatigue and the Effects of Alternating Hands in the Prehospital Setting: Prospective Randomized Pilot Study using Pediatric Manikin Simulation Trial

PURPOSE: One-handed chest compression (OHCC) technique is performed by one hand. Therefore chest compression (CC) depth might decrease rapidly. This study will evaluate the patterns of CC depth decaying in performing OHCC and assess the effects of alternating the hand which performs CC on the patterns of CC depth decaying. METHODS: This study was designed as a prospective randomized manikin simulation trial. Students of medical college participated. First, 10 students performed OHCC (chest compression:ventilation=30:2) in a pediatric manikin lying on a hard floor for 5 minutes (baseline study). After the baseline study, 32 students were recruited and randomized to group A and B. Group A performed OHCC with hand shift every other cycle (test 1). Group B performed OHCC with hand shift when they feel fatigue (test 2). The compression data were collected using the CPRmeter. The mean compression depths (MCD) were calculated at one minute intervals using the Q-CPR review software. The heart rates were monitored and the fatigue scales were collected every 1 minute. RESULTS: The MCD values were decreased significantly after 1 minute in the baseline study (p<0.05). However they were not changed in test 1 and decreased significantly after 4 minutes in test 2 (p<0.05). The heart rate and the fatigue scales were increased significantly with time in all tests (p<0.05). CONCLUSION: When OHCC was performed without shifting the hand which performed CC, the MCD decreased significantly after 1 minute. However, we could delay the time of decreasing MCD by shifting the hand which performed CC.

Effects of Counting Chest Compressions on the Performance of Cardiopulmonary Resuscitation: Prospective Randomized Pilot Study Using Manikin Simulation Trial

PURPOSE: This study compared the effects of counting chest compressions verbally and silently on the performance of cardiopulmonary resuscitation (CPR). METHODS: Forty-six medical students were enrolled in this study. After the participants performed a two-min CPR (Test 1), during which they counted each compression silently, they were divided randomly into Groups A and B. After a 30-min rest, the participants took Test 2. In Test 2, Group A performed two-min CPR, during which the participants counted the number of chest compressions verbally (Test 2A), and in Group B, CPR was performed using the same methods as detailed for Test 1 (i.e., with silent enumeration; Test 2B). Each student counted the number of chest compressions aloud from one to 30 in Test 2A. RESULTS: No significant differences were observed for either test (Tests 1 and 2) between Groups A and B. Although the mean compression rate (MCR) was increased significantly from 107.2+/-15.4 to 116.3+/-15.9/min between Tests 1 and 2B in Group B (p<0.01), a similar result was also obtained in Group A. In the individual interviews conducted with the Group A participants, all members reported having difficulty breathing while counting the number of chest compressions verbally when compared with silent enumeration. CONCLUSION: Tallying the numbers of chest compressions verbally did not significantly alter the performance of CPR.

Effects of the Mobile Phone Speaker Function on the Dispatcher-assisted Layperson Performance of Early Phase Cardiopulmonary Resuscitation

PURPOSE: The effects of the mobile phone speaker function, which makes it possible to communicate continuously and to allows the free use of two hands, during the early phase of cardiopulmonary resuscitation (CPR) by dispatcher-assisted laypersons were investigated through a mannequin-based simulation study. METHODS: Fifty volunteers were randomly assigned to "non-speaker function CPR" (NSFCPR) (n=25) and "speaker function CPR" (SFCPR) (n=25). Fifty compressions of "Hands-only CPR" were performed according to telephone-instructed CPR by dispatchers with or without the speaker function. The quality of CPR administered and interviews from laypersons on the difficulties of performing CPR were examined. RESULTS: There were no significant differences in compression rate, depth, incomplete chest recoil, and time to first compression between the two groups. However, fourteen participants in the NSFCPR group (56.0%) and five participants in the SFCPR group (20.0%) reported interrupted chest compression (p=0.042). There were twenty-eight events of interruption in the NSFCPR group and twelve in the NSFCPR group (p=0.008). The most common cause of interrupted chest compression were difficulties in hearing the dispatcher's instructions (23, 57.5%). All 13 cases for position correction (32.5%) were observed in the NSFCPR group. There were significant differences between the two groups in causes and counts of compression interruption (p=0.004). CONCLUSION: There was difference in the interruption of compression and there were no differences in CPR performance between two groups. Still, the speaker function may reduce the interruption of chest compression due to phone holding, permitting a clearer hearing of instructions.

Symptoms from an Overdose of Caffeine

Caffeine is a very popular compound widely available in various beverages. It is generally regarded as safe, but several lethal outcomes have been reported after large overdoses. A 21-year-old woman was brought to the emergency department (ED) after ingestion of approximately 100 caffeine tablets, each containing 200 mg, resulting in a total amount of about 20,000 mg of caffeine. She was very irritable and complained about nausea, vomiting, and headaches. While the initial electrocardio graphy (ECG) showed ventricular bigeminy, most of the patient's symptoms were gone after supportive care with anti-emetics and benzodiazepine. The rhythm was converted to a sinus rhythm without anti-arrhythmics. Because caffeine tablets are unavailable in Korea, acute large-dose caffeine overdoses have been relatively rare. However, there is an increasing risk of caffeine exposure through highly concentrated "energy drinks" or caffeine tablets from purchases on-line. Thus, physicians should be prepared to deal with the severe toxic effects of an acute caffeine over-dose.

Assessment of Intershift Handoff in Emergency Medicine Training Hospitals in Korea

PURPOSE: Shift work is inherent to emergency medicine practice. However, the intershift handoff between emergency physicians has been identified as a high-risk area for medical errors. We evaluated the current handoff processes in an emergency department in Korea and the attitudes of emergency medicine residents toward the need for standardized guidelines. METHODS: A questionnaire survey was conducted on emergency medicine residents working in training hospitals (one resident per hospital) in Korea. The questionnaire asked about the current handoff method, whether there was a standardized handoff format, and asked residents on their experiences and opinions about the handoff practice. RESULTS: A total of 29 emergency medicine residents responded to the survey. A majority of hospitals were found to have no uniform handoff format in their emergency department (26 hospitals, 90%). In addition, only a small number of hospitals had an educational program for intershift handoff (7 hospitals, 24%). A large majority of responders (97%) reported experiencing medical errors related to handoff. CONCLUSION: There is currently a significant lack of handoff format or educational programs on intershift handoff in Korean emergency medicine training hospitals. Further research and effort for the establishment of effective standardized handoff and training programs are strongly needed.

Safety Evaluation of Stamp Type Digital Microneedle Devices in Hairless Mice

BACKGROUND: Microneedles provide a minimally invasive means to transport molecules into the skin. A number of specific strategies have been employed to use microneedles for transdermal delivery. OBJECTIVE: The purpose of this study was to investigate the safety of two new digital microneedle devices (Digital Hand(R) and Digital Pro(R); Bomtech Electronics Co., Ltd., Seoul, Korea) for the perforation of skin in skin-hairless-1 mice. This device replaces conventional needles and is designed specifically for intradermal delivery. METHODS: We used two newly developed digital microneedle devices to perforate the skin of skin-hairless-1 mice. We conducted a comparative study of the two digital microneedle devices and DTS(R) (Disk type-microneedle Therapy System; DTS lab., Seoul, Korea). To evaluate skin stability, we performed visual and dermatoscopic inspections, measurements of transepidermal water loss, and biopsies. RESULTS: The two novel digital microneedle devices did not induce significant abnormalities of the skin on visual or dermatoscopic inspection, regardless of needle size (0.25~2.0 mm). No significant histopathological changes, such as inflammatory cell infiltration, desquamation of the stratum corneum, or disruption of the basal layer, were observed. The digital microneedle devices and microneedle therapy system produced similar results on measures of skin stability. CONCLUSION: These two novel digital microneedle devices are safe transdermal drug delivery systems.

Effects of Audio Tone Guidance on Performance of Positive-pressure Ventilation using a Bag-valve Device

PURPOSE: The 2010 guidelines for cardiopulmonary resuscitation recommend a ventilation rate of 8 to 10/min for patients with an advanced airway; however, hyperventilation occurs in most cases. This study was conducted as an attempt to determine the effects of feedback under audio tone guidance on performance of positive-pressure ventilation using a bag-valve device and to apply this technique in clinical practice in order to reduce hyperventilation. METHODS: A total of 36 seniors at our medical school participated in the study. After receiving instruction in performance of positive-pressure ventilation using a bag-valve device, they performed ventilation using a cardiac arrest model with an advanced airway (Test 1). After they took Test 1 without any feedback, they were randomly assigned to the feedback group (Group A) and the control group (Group B) and took Test 2. In Group A, a high-pitched sound was delivered every 7 s for guidance of ventilation. RESULTS: In Group A, ventilation rate approximated feedback rate, whereas, in Group B, it showed a significant decrease, from 8.3+/-2.0 to 7.7+/-2.0/min (p<0.01). The mean ventilation volume did not differ between pre- and post-feedback. The mean inspiration time showed a decrease in both groups. However, no significant difference in mean inspiration time was observed between the two groups. CONCLUSION: Audio tone guidance can control the ventilation rate accurately without any significant change in ventilation volume and inspiration time.

The S100B Protein Could Be Used as Adjuvant Diagnostic Tool in Acute Ischemic Stroke / 대한구급학회지

BACKGROUND: In the emergency department, the diagnosis of ischemic stroke is difficult because the diagnostic modalities are limited to non-contrast brain CT and neurologic examination. Serum S100B protein, a bio-marker for ischemic stroke, is needed as an additional diagnostic aid in acute ischemic stroke. METHODS: We retrospectively reviewed 50 patients diagnosed with ischemic stroke between August 2007 and December 2008 by brain MRI after brain CT and serum S100B measurement in the emergency department. The serum levels of S100B protein were analyzed and the diagnostic sensitivity of non-contrast brain CT combined with abnormal elevation of S100B protein was compared with that of non-contrast brain CT alone. RESULTS: The overall sensitivity of non-contrast brain CT in the diagnosis of ischemia was 54%. S100B protein in early ischemia had a sensitivity of 58%. However, combining non-contrast brain CT and S100B increased the sensitivity to 74%. CONCLUSIONS: A biomarker-based diagnostic test would not replace the necessity for CT or other early imaging studies, and before contemplating any reperfusion strategy, neuro-imaging must be performed to rule out intracranial hemorrhage. However, S100B protein, a serum bio-marker, is able to help emergency physicians evaluate patients with suspected ischemic stroke and decide on treatment.

Distribution of Malassezia Species on the Scalp in Korean Seborrheic Dermatitis Patients

BACKGROUND: Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE: To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS: A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS: The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION: M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.

Effectiveness of Medical Student Training and Performance Assessment for Initial Evaluation and Management of Patients with Multiple Trauma, Using Realistic Patient Simulation

PURPOSE: Simulation-based medical education allows medical students to experience scenarios that are otherwise rare to encounter during on-site training. The purpose of our study is to assess the performance of a medical student training program using a realistic, patient simulation for activities including initial evaluation and management, situational judgment, and decision making associated with patients with multiple trauma. METHODS: After a slide lecture and patient simulation training, 46 medical students in their sixth-year were trained using a multiple-trauma patient simulation scenario. The performance assessment checklist included possibilities for both appropriate and inappropriate actions. After debriefing, the students filled out a questionnaire and participated in a feedback session. Two specialists in emergency medicine evaluated the completed checklists. Inter-rater reliability was established for the results. RESULTS: The appropriate action checklist items for obtainment of blood for type and crossmatch, initiation of emergency blood transfusion, and resuscitation with vigorous fluid therapy, resulted in low mean numbers. The inappropriate action checklist items for delay in recognition of tension pneumothorax, blood ordering type and crossmatch, and ordering blood transfusion, resulted in high mean numbers. The inter-rater reliability of these results were 0.90. Students responded in the questionnaire that they appreciated the opportunity to have this training before graduation and that they had learned more about multiple trauma treatment through this training. CONCLUSION: We suggest that this training program, using a realistic patient simulation, can be highly effective for teaching medical students about initial evaluation and management, situational judgment, and decision making in patients suffering with multiple traumas. We also demonstrated the efficacy of simulation as a trauma performance assessment tool for evaluating medical students.

Does The Drinking Behavior of Interns and Residents Affect Their Attitudes Toward the Screening, Brief Intervention and Referral to Treatment (SBIRT) Regarding Alcohol?

PURPOSE: We investigated the relationship between the drinking behavior of primary healthcare providers (interns and residents) and their attitude toward the screening, brief intervention, and referral to treatment (SBIRT) questionnaire used for problem-drinking patients in an emergency department and an outpatient clinic. METHODS: Our survey was sent to interns and residents in two university hospitals. The survey inquired about (1) primary healthcare providers' AUDIT (Alcohol Use Disorder Identification Test) score, (2) self diagnosis of their own drinking behavior, and (3) the attitude of problem drinking patients toward the SBIRT. We analyzed for correlations between drinking behavior and SBIRT scores. RESULTS: A total of 109 interns and residents completed the survey. The component of ratio between the normal group, risky drinking group and the alcohol use disorder group of respondents was 43.1%, 40.4% and 16.5%, respectively. The proportion of risky drinking + alcohol use disorder among our subjects was higher than in the general population. Using the AUDIT scoring method drinking behavior diagnosis and self diagnosis were correlated (p<0.05). The ratio for the normal group that disagreed for alcohol screening test's necessity (59.6%) was higher than for the risky drinking group (34.1%) and alcohol use disorder group(38.9%) (p=0.041) and shows that doctors' own drinking behavior may affect enforcement of the drinking screening test for patients. CONCLUSION: Our research suggests that alcohol use among doctors affects their attitude towards the implementation of drinking screening tests (SBIRT) for patients. Also, doctors have a higher rate of problem drinking than the general population. Those doctors in the problem-drinking group are more likely to think that they do not have any problems with their own drinking behavior and they do not agree with the necessity of a drinking screening test more than brief intervention, and referral to treatment We believe that interns and residents need medical education and self-awareness training with regards to the effects of alcohol.

The Relationship Between the Time-distribution of EMS Demands and the Transport Time of 119 Ambulances

PURPOSE: As the prevalence of emergency diseases such as cardiac, cerebrovascular and respiratory disease has increased, the demands on the emergency medical service (EMS) system have also increased. But the resource of the EMS can't be expanded to meet the increased demands. So, due to the limited resources and the increased EMS call volume, the efficacy of EMS has decreased. In this study, we analyzed the relationship between the call volume and EMS transport time with respect to the EMS efficacy. METHODS: We retrospectively reviewed the computerized log data of the EMS ambulances in a metropolitan city of Korea. During the period from January 2008 to December 2008, a total 74,349 EMS calls developed and in 50,661 cases an EMS ambulance was dispatched to transport patients to a hospital. The time-distribution of the EMS demands and the time of EMS ambulance transport were analyzed according to the date, time and location of the calls to the EMS. Other characteristics of the EMS such as triage and disease or injury were analyzed. The transport time of the dispatched ambulance was compared between within the jurisdiction and outside the jurisdiction for evaluating the efficacy of the EMS system. RESULTS: During dawn (00:00-08:00) the frequency of EMS calls was low, as compared with that of the day and night (08:00-24:00). During dawn, 12,098 (23.88%) patients were developed, but 38,563 (76.12%) patients were developed during the day and night. On comparison according to jurisdiction, the response time and total transport time of the ambulance dispatched within the jurisdiction were faster than that outside the jurisdiction (p<0.001). During day and night, more ambulances were dispatched outside the jurisdiction that that during dawn (p<0.001). CONCLUSION: In a situation that there are many simultaneous demands for EMS in the same area, insufficient EMS resources can't quickly and effectively service all the demands. So, the time-distribution of EMS calls can assessed according to the dispatched EMS ambulances. Using our data, EMS resources can be redistributed to increase the efficiency of EMS.