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1.
MedEdPORTAL ; 15: 10791, 2019 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-30800991

RESUMEN

Introduction: The science of patient safety demonstrates that good communication is essential for effective interprofessional collaboration. Methods: We created a low-stakes, formative assessment with which medical students, pharmacy students, and nursing students could practice several of the Interprofessional Education Collaborative competencies. We aimed to enable students to practice collaborative care, respect for other disciplines, and shared accountability. Senior students from medicine, nursing, and pharmacy worked in teams to disclose a medical error to a standardized patient. The activity began with an icebreaker exercise wherein students learned about each other. Next, each team planned a strategy for error disclosure and collaboratively disclosed the error. Standardized patients evaluated the team's performance. Subsequently, students regrouped for a debriefing. The participating institutions administered a survey to their students. Results: In total, 1,151 students participated: 464 fourth-year students from the University of Houston College of Pharmacy, 450 third- and fourth-year students from Baylor College of Medicine, and 237 fourth-year students from Texas Woman's University Nelda C. Stark College of Nursing, all in Houston, Texas. Postsession survey data showed that students thought they achieved the relevant competencies. Students' understanding of the perspectives of the other two disciplines improved. Students found the simulation encounter and debriefing effective in helping them consider the contributions of other disciplines to patient care. Discussion: This interprofessional standardized patient activity enabled collaborative problem solving. The debriefing discussion broadened students' understanding of the expertise of the other disciplines and promoted shared accountability. Students found this activity engaging and effective.

2.
Med Educ ; 51(7): 708-717, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28418106

RESUMEN

BACKGROUND: Barriers hinder medical students from reporting breaches in professional behaviour, which can adversely impact institutional culture. No studies have reported student perspectives on how to address these barriers successfully. Our study (i) evaluated the likelihood of reporting based on violation severity, (ii) assessed barriers to reporting and (iii) elicited students' proposed solutions. METHODS: Four medical students designed a cross-sectional study in 2015. In response to seven scenarios, students rated the likelihood of reporting the violation, indicated perceived barriers and identified solutions. Additional questions investigated the perceived importance of professionalism, confidence in understanding professionalism and trust in administrative protection from negative consequences. RESULTS: Two hundred and seventy-two students in their clinical years (MS2-4) responded to the survey (RR = 50%). Students were 70-90% likely to report major violations, but < 30% likely to report minor or moderate violations. Barriers included concerns about an uncomfortable relationship (41%), potential negative repercussions on grades or opportunities (23%), and addressing by direct discussion rather than reporting (23%). Solutions included simplified reporting, control over report release date, improved feedback to reporters, training for real-time resolution of concerns and a neutral resource to help students triage concerns. No differences existed between classes regarding the importance or understanding of professionalism. In linear regression, only importance of professionalism predicted likelihood of reporting and this did not change with training. CONCLUSIONS: Hindered by common barriers, students are unlikely to report a violation unless it is a serious breach of professionalism. Student-derived solutions should be explored by medical school administrators to encourage reporting of violation of professionalism.


Asunto(s)
Ética Profesional , Mala Conducta Profesional , Estudiantes de Medicina , Estudios Transversales , Retroalimentación , Humanos , Facultades de Medicina , Encuestas y Cuestionarios
3.
Med Educ Online ; 22(1): 1289315, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28219315

RESUMEN

BACKGROUND: Accrediting bodies require medical schools to teach patient safety and residents to develop teaching skills in patient safety. We created a patient safety course in the preclinical curriculum and used continuous quality improvement to make changes over time. OBJECTIVE: To assess the impact of resident teaching on student perceptions of a Patient Safety course. DESIGN: Using the Institute for Healthcare Improvement patient safety curriculum as a frame, the course included the seven IHI modules, large group lectures and small group facilitated discussions. Applying a social action methodology, we evaluated the course for four years (Y1-Y4). RESULTS: In Y1, Y2, Y3 and Y4, we distributed a course evaluation to each student (n = 184, 189, 191, and 184, respectively) and the response rate was 96, 97, 95 and 100%, respectively. Overall course quality, clarity of course goals and value of small group discussions increased in Y2 after the introduction of residents as small group facilitators. The value of residents and the overall value of the course increased in Y3 after we provided residents with small group facilitation training. CONCLUSIONS: Preclinical students value the interaction with residents and may perceive the overall value of a course to be improved based on near-peer involvement. Residents gain valuable experience in small group facilitation and leadership.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Seguridad del Paciente , Grupo Paritario , Competencia Clínica , Curriculum , Educación de Pregrado en Medicina/normas , Humanismo , Humanos , Internado y Residencia , Mejoramiento de la Calidad , Rol , Estudiantes de Medicina , Enseñanza
4.
MedEdPORTAL ; 13: 10595, 2017 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-30800797

RESUMEN

Introduction: Patient safety education is required in medical, nursing, and pharmacy training, and interprofessional education offers an ideal format for teaching the core concepts of patient safety. This training activity was developed to fulfill interprofessional education core competencies for communication and teamwork and was nested within a required patient safety course taught at a medical school. However, the activity can easily be adapted as a stand-alone offering that can be included in a preclinical doctoring course, offered as an elective, or hosted at a college of nursing or pharmacy. Our goal was to prepare learners for the clinical environment by providing a context for patient safety, communication, and teamwork. Methods: Students participate in a 1.5-hour large-group activity that explores a case from the perspectives of each discipline. Faculty from all three disciplines sequentially present and debrief the case using focused questions to guide students' reflections and interactions between team members. Results: We have presented this activity for 4 consecutive years. Students complete a questionnaire with retrospective pre-post ratings of their perspectives on the activity and its impact on their awareness of disciplinary roles and responsibilities, communication errors, and strategies for addressing interdisciplinary conflicts. Results show statistically significant increases in the items of interest. Discussion: This interprofessional education offering is effective in terms of increasing awareness and knowledge among members of three health care disciplines, improving awareness of potential kinds of communication errors, and helping students consider the role of interdisciplinary interactions.

5.
Med Teach ; 37(2): 136-9, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24819504

RESUMEN

Much has been written about how we understand, teach and evaluate professionalism in medical training. Less often described are explicit responses to mild or moderate professionalism concerns in medical students. To address this need, Baylor College of Medicine created a mechanism to assess professionalism competency for medical students and policies to address breaches in professional behavior. This article describes the development of an intervention using a guided reflection model, student responses to the intervention, and how the program evolved into a credible resource for deans and other educational leaders.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Educación de Pregrado en Medicina/organización & administración , Rol del Médico , Estudiantes de Medicina/psicología , Conducta , Humanos , Desarrollo de Programa
6.
J Palliat Med ; 16(11): 1342-9, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23937062

RESUMEN

BACKGROUND: Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes. OBJECTIVE: Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism. METHODS: After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme. RESULTS: Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill). CONCLUSIONS: Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.


Asunto(s)
Educación de Pregrado en Medicina , Cuidados Paliativos , Competencia Profesional , Estudiantes de Medicina/psicología , Escritura , Adulto , Curriculum , Empatía , Femenino , Humanos , Masculino
7.
Med Teach ; 35(4): e1082-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23102159

RESUMEN

BACKGROUND: To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. AIMS: We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard. METHODS: Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. RESULTS: Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. CONCLUSIONS: Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.


Asunto(s)
Sesgo , Disonancia Cognitiva , Educación de Pregrado en Medicina , Estudiantes de Medicina/psicología , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino
8.
J Palliat Med ; 15(7): 784-9, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22686121

RESUMEN

BACKGROUND: Despite broad support for palliative and end-of-life care training in medical schools, required clinical palliative care and end-of-life experiences are rare. In this study, we assess the impact of a required palliative care educational intervention on medical students' palliative care pain knowledge and end-of-life attitudes. METHODS: In this wait-list control crossover design, third-year medical students from two sequential classes (n=157) completed a palliative care workshop at the beginning of a required year-long course. Students then completed a patient experience, online pain management module, and reflective essay in either the first or second half of the course. Fifteen validated multiple choice palliative care pain management items and the Thanatophobia Scale (7 items) were administered to measure knowledge and attitudes for all students at baseline, 5.5 months, and 11 months. Multivariate repeated measures ANOVA was used to determine differences between groups and across time. RESULTS: Analysis found statistically significant increases in knowledge and improvements in attitudes (p<0.001) across the time points as well as a statistically significant interaction effect between time and groups (p=0.006). These changes correspond to specific curricular intervention components in which attitudinal improvements are seen after the workshop, and knowledge increases are seen after the patient experience, online pain module, and reflective essay. CONCLUSION: A modest, required palliative care curriculum can yield improvements in medical student knowledge and attitudes. However, expansion of the experiential component and palliative care skills training and assessment are needed for students to have more meaningful outcomes and to ultimately contribute to better patient outcomes.


Asunto(s)
Curriculum , Educación de Pregrado en Medicina , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Cuidado Terminal , Wisconsin
9.
Med Educ ; 46(1): 80-8, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22150199

RESUMEN

CONTEXT: For the last 30 years, developments in cognitive sciences have demonstrated that human behaviour, beliefs and attitudes are shaped by automatic and unconscious cognitive processes. Only recently has much attention been paid to how unconscious biases based on certain patient characteristics may: (i) result in behaviour that is preferential toward or against specific patients; (ii) influence treatment decisions, and (iii) adversely influence the patient-doctor relationship. Partly in response to accreditation requirements, medical educators are now exploring how they might help students and residents to develop awareness of their own potential biases and strategies to mitigate them. METHODS: In this paper, we briefly review key cognition concepts and describe the limited published literature about educational strategies for addressing unconscious bias. DISCUSSION: We propose a developmental model to illustrate how individuals might move from absolute denial of unconscious bias to the integration of strategies to mitigate its influence on their interactions with patients and offer recommendations to educators and education researchers.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Prejuicio , Actitud , Diversidad Cultural , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Médico-Paciente , Valores Sociales
10.
J Gen Intern Med ; 25 Suppl 2: S115-8, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20352504

RESUMEN

INTRODUCTION/AIMS: Implicit bias can impact physician-patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care. SETTING: Seventy-two third-year medical student volunteers participated in facilitated small group discussions about bias. PROGRAM DESCRIPTION: We tested an educational intervention to promote group-based reflection among medical students about implicit bias. PROGRAM EVALUATION: We assessed how the reflective discussion influenced students' identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session (chi(2)(11) = 27.93, p < 0.01), including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies. DISCUSSION: Group-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.


Asunto(s)
Actitud del Personal de Salud/etnología , Competencia Cultural/psicología , Disparidades en Atención de Salud , Intención , Prejuicio , Estudiantes de Medicina/psicología , Humanos
11.
Arch Psychiatr Nurs ; 16(4): 168-75, 2002 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12143076

RESUMEN

The purpose of this study was to identify risk factors that may be predictive of posttraumatic stress disorder (PTSD) in children after a traumatic injury. The study was a retrospective review of data collected from 337 pediatric trauma patients treated in a multidisicplinary outpatient clinic. Results from Chi-square and t-test analyses indicated that gender, ethnicity, age, and injury severity were not risk factors for PTSD. However, mechanism of injury, specifically a gun shot wound (p =.001), was associated with development of PTSD, as was body area of injury, specifically the abdomen (p =.001). Psychiatric screening of patients with gun shot wounds and wounds to the abdomen may help with the early identification and treatment of PTSD.


Asunto(s)
Trastornos por Estrés Postraumático/epidemiología , Heridas y Traumatismos/psicología , Escala Resumida de Traumatismos , Traumatismos Abdominales/psicología , Accidentes por Caídas , Adolescente , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos , Factores de Riesgo , Trastornos por Estrés Postraumático/etiología , Texas/epidemiología , Heridas y Traumatismos/etiología , Heridas por Arma de Fuego/psicología
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