Identifying teaching competencies for medical residents using a modified Delphi method.

PURPOSE: This study aimed to identify the teaching competencies of medical residents. METHODS: A modified Delphi study was conducted from January to March 2017. Twenty-four panelists (six medical educators, program directors, chief residents, and residents each) from various facilities in Japan participated in the study. The consensus criterion for this study was that more than 80% of the panelists gave a rating of 6 or higher on the 7-point Likert scale ("not at all important" to "extremely important") without any comments. The modified Delphi approach resulted in a list of 27 resident teaching competencies after three rounds. These competencies were categorized based on Harden and Crosby's 12 roles of medical teachers. RESULTS: Our study revealed that, of the 12 roles, residents were primarily viewed as "clinical or practical teachers," "teaching role models," "on-the-job role models," "learning facilitators," and "student assessors." CONCLUSION: The 27 resident teaching competencies indicate the importance of educational proximity for residents as teachers. It is expected that this finding will contribute to competency-based resident-as-teacher education.

"Diagnose, Treat, and SUPPORT". Clinical competencies in the management of older adults with aspiration pneumonia: a scoping review.

BACKGROUND: Aspiration pneumonia in older adults is increasingly common, with a high care burden and morbidity. However, clinical competencies in its management have not been developed, and healthcare professionals struggle on how to care for these patients with multimodal treatment needs. Therefore, we conducted a scoping review to investigate what is known about the desired clinical competencies for the management of older adults with aspiration pneumonia, to utilise in clinical practice, education, and future research. METHODS: First, we defined aspiration pneumonia according to a preliminary search. We then searched the literature on MEDLINE and CINAHL, focusing on studies involving patients aged 65 years old and older diagnosed with aspiration pneumonia. All settings were included, with the exception of intensive care units. Publication dates were limited to January 2011 to July 2022 and languages to English and Japanese. The extracted data were used to refine the preliminary competency framework developed by the Japan Aspiration pneumonia inter-Professional team Educational Program (JAPEP) in preparation of this study. RESULTS: Ninety-nine studies were included. Following data extraction from these studies, 3 competencies were renamed, and 3 new competencies were added, to create a list of 12 competencies. These were Diagnosis, Treatment, Swallow Assessment, Underlying condition management, Nutrition, Oral management, Rehabilitation, Multidisciplinary team, Decision making, Prevention, Prognosis, and Palliative care. CONCLUSIONS: Our scoping review identified 12 clinical competencies required in the management of older adults with aspiration pneumonia, outlined in the phrase 'Diagnose, Treat and SUPPORT'. We encourage healthcare professionals to share these competencies as a team to identify areas of unmet need and improve their patient care, with an emphasis on supportive care.

Nonbacterial Thrombotic Endocarditis Associated with Acute Promyelocytic Leukemia: An Autopsy Case Report.

Valve vegetation is one of the most fearful findings for physicians. The first diagnosis that comes to their mind is infective endocarditis (IE), but it can also be noninfective; nonbacterial thrombotic endocarditis (NBTE). NBTE can be even more challenging than IE for physicians because of the wide range of differential diagnoses such as malignancies, autoimmune disorders and human immunodeficiency virus. A 45-year-old woman presented at the emergency room with a sudden onset of dysarthria and right-sided hemiplegia. Laboratory data showed her blood counts and coagulation test were mostly normal and the magnetic resonance imaging detected a high-signal-intensity change in her left brain. An echocardiogram found a vegetation-like structure on her atrial valve. We highly suspected IE leading to cerebral embolism. The clot was successfully removed by our neurosurgeons and anticoagulation therapy was started concurrently. Her state of consciousness improved, but then she suffered a brain hemorrhage and died. The autopsy revealed that the cause of her vegetation was acute promyelocytic leukemia (APL). Based on these findings, it is important to remember that APL can be the cause of NBTE even if the blood count and coagulation tests are almost normal.

The Association between the Establishment of a General Internal Medicine Department and an Increased Number of Blood Cultures in Other Departments: An Interrupted Time Series Analysis.

Objective The establishment of a department of general internal medicine (GIM) has been shown to improve the clinical outcomes among patients treated in GIM departments but the effect on practice patterns in other departments remains unclear. We evaluated the association between the establishment of a GIM department and the use of blood cultures, an indicator of quality of care of infectious diseases, in other departments. Methods This study was conducted between 2013 and 2017 in a community hospital which established a new GIM department in 2015, with a mandate to improve the quality of care of the hospital including infectious disease management. The primary outcome was the change in the number of blood culture episodes per calendar month in other departments before and after establishment of the GIM department. The secondary outcome was the change in the blood culture episodes per month, indexed to 1,000 patient-days, during the same time. Using 2015 as the phase-in period, interrupted time series analyses were used to evaluate the change in the outcome variables. Results In departments other than GIM, there were 284 blood cultures prior to the establishment of the GIM department (2013-2014) and 853 afterwards (2016-2017). The number of blood culture episodes in other departments increased by 10.7 (95%CI: 0.39-21.0, p=0.042) per calendar month after the establishment of the GIM department; blood culture episodes/calendar month/1,000 patient-days increased by 0.55 (95%CI: 0.03-1.07 p=0.037). Conclusion These results indicate that a GIM department in a community hospital can improve the quality of care in other departments.

Efficacy and safety of endoscopic submucosal dissection for non-ampullary duodenal polyps: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is commonly used to treat early-stage digestive cancer because it results in a higher frequency of en-bloc resection and a lower frequency of local recurrence. However, the efficacy and safety of duodenal ESD remain unclear. Therefore, present study is aimed at evaluating clinical outcomes of duodenal ESD. METHODS: To evaluate the efficacy and safety of duodenal ESD, electronic databases (MEDLINE, CENTRAL and EMBASE) were searched by two independent reviewers. The authors were contacted for additional information. A meta-analysis was performed to evaluate the efficacy and safety of duodenal ESD. RESULTS: A total of 7 studies (203 patients) were included in the quantitative synthesis analysis. The pooled proportions of the frequencies of en-bloc resection, need for surgical intervention, bleeding, intraoperative perforation and delayed perforation were 87%, 4%, 2%, 15% and 2%, respectively. The quality of evidence regarding on surgical intervention outcomes was rated as moderate, whereas that of en-bloc resection was rated as low because of its marked inconsistency. CONCLUSIONS: Duodenal ESD produced acceptable outcomes in terms of the en-bloc R0 resection, but the incidence of procedure-related adverse events is high (PROSPERO register, CRD42017057110).

Development and efficacy of a clinician-targeted refresher course for treating nonpneumonia respiratory tract infections.

BACKGROUND: In 2017, the Japanese government published an evidence-based manual describing the appropriate use of antibiotics in outpatient settings to tackle the problem of antimicrobial resistance. To fill the evidence-practice gap, we developed a clinician-targeted course aimed at improving clinician skills in the daily clinical practice of treating acute respiratory tract infections (RTIs) based on the manual. The aim of this study was to evaluate the efficacy of the course. METHODS: This course consisted of lectures using illness scripts and checklists, as well as interactive communication skills training using role-playing. We performed a vignette-based evaluation of the changes in the knowledge and attitudes of the course participants toward prescribing antibiotics for nonpneumonia RTIs, using pre- and postcourse questionnaires. The questionnaires also included course feedback via the use of a 5-point Likert scale. RESULTS: Thirty-eight clinicians were included in the analyses, and 90% of these participants had graduated ≥20 years ago. We found statistically significant reductions in the intention to prescribe antibiotics for four of the six nonpneumonia RTI vignettes: acute bronchitis (-47.2%; 95% confidence interval [CI] -66.3 to -28.1%), common cold (-16.2%; 95% CI -30.8 to -1.6%), acute pharyngitis (-27.0%; 95% CI -49.0 to -5.0%), and acute rhinosinusitis (-33.3%; 95% CI -53.3 to -13.3%). The course seemed to be satisfactory for experienced doctors who were the relevant target population of such a workshop. CONCLUSIONS: The refresher course was helpful for reducing the participants' intensions to prescribe antibiotics for nonpneumonia RTIs.