Virtual student-transplant patient interactions empower patients and enhance student transplantation knowledge.

INTRODUCTION: There is variation in exposure to transplantation in undergraduate medical education. We created a program pairing medical students with transplant patients for semi-structured, virtual encounters and studied the impact on both students and patients using qualitative content analysis. METHODS: Fifty medical students were paired with transplant recipients and donors for non-medical virtual encounters. Separate focus groups were conducted, deidentified, and analyzed using a constant comparative method. RESULTS: Three themes related to the student experience emerged: transplant-related relationships, a deeper understanding of the patient's journey to transplant, and alterations of their personal view of organ donation and transplantation. Three themes emerged from the patient's experiences: the benefits of conversations, the patient as a teacher, and spreading the message of organ donation and transplantation. CONCLUSIONS: This novel program demonstrates that virtual student-patient interactions are a useful approach to engage patients and a unique way to teach medical students about transplantation and donation.

Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce.

BACKGROUND: Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS: Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS: From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant's rank list, and proportion of unfilled fellowship positions (each, p < 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS: Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates.

Engaging high school students about organ donation and transplantation: an evaluation of the High School Outreach Initiative (HSOI) program.

Adolescents can be influential in changing societal perceptions of organ donation and transplantation (ODT) but current studies on youth are limited. We sought to (1) assess the baseline knowledge in ODT among students in Toronto, Canada, and (2) evaluate the effectiveness of the High School Outreach Initiative (HSOI) program presentations in changing awareness and interest about ODT. Pre- and post-presentation surveys were administered to high school students about their knowledge of ODT, awareness of donor registration, importance of donation, intent to register, and willingness to talk to their families about donation. Descriptive statistics were used to characterize the students' baseline knowledge and interest. Wilcoxon and McNemar tests were used to analyze changes in perceptions before and after the presentation. A total of 449 HSOI presentations were delivered to 33,090 students at 102 high schools in the Greater Toronto Area between 2012 and 2019. Data from 3327 surveys completed by students before a presentation showed 46.5% were not knowledgeable about ODT. For the 2-year period between 2017 and 2019, 1224 matched pre- and post-presentation surveys were collected. The 49.8% of students who stated they were not knowledgeable about ODT prior to the presentation decreased to 3.8% after (p < 0.001). Those who were not willing to register decreased by half after the presentation (p < 0.001). The HSOI is an effective educational program in improving youth's attitudes and perceptions toward ODT. Further directions of the program include the expansion to other cities and the collection of demographic information of students.

Development and application of a massive open online course to deliver innovative transplant education.

Massive Open Online Courses (MOOCs) offer an entirely new course concept for delivering content and engaging learners. This method of teaching has huge potential for the field of transplant education. In this study we describe the development and implementation of the MOOC "Clinical Kidney, Pancreas and Islet Transplantation". Three and a half years after the introduction of the course, the learning demographics have been analyzed. The majority of learners were from Europe, North America and Asia. The course has been offered at several different stages of education at Leiden University Medical Center from undergraduate to continuous medical education. The level of engagement with the content was associated with the background and motivations of the learners. 74% had a bachelor's degree or higher. 48% of the undergraduate students participated in other content than instructed. Learners reported having liked the design of the course. Personal growth was the main motivation for 93% of worldwide learners. 69% considered the content of the MOOC to be relevant to their job. In general student's intentions focused more on reasons of personal growth, general interest, and relevance to school or degree program. Overall the integration of the MOOC in different settings of formal transplant education offered an added value to the on-campus program.

Developing an Organ Donation Curriculum for Medical Undergraduates in China Based on Theory of Planned Behavior: A Delphi Method Study.

BACKGROUND Organ donation education as an important approach to improve support for donating, but it is inconsistent and unstructured. Therefore, the development of donation-related curriculum is essential, especially for medical undergraduates. This study aimed to define the fundamental contents for organ donation curriculum that could be useful for international organ donor agencies and educational institutions. MATERIAL AND METHODS The basic framework of the organ donation curriculum was constructed under the guidance of the theory of planned behavior in China. Then, Delphi method was used to modify and improve the contents by conducting 2 rounds of consultation with 22 Chinese experts from 6 professional fields. The surveys winnowed the list and assessed the accuracy and importance of each item. RESULTS Response rates for the Delphi were 100.00% for the first round and 95.45% for the second round. A 3-layer curriculum system was developed based on 3 dimensions of the theory of planned behavior. The primary-layer items including the overview, cultural concepts, ethical issues, laws and regulations, medical knowledge, and psychological care in organ donation, elicited at least 85% of the experts to agree or strongly agree that the items were basic and core content for organ donation education. All of the 17 second-layer and 46 third-layer items also had 80% or more expert agreement. CONCLUSIONS This study identified the contents of an organ donation curriculum for medical undergraduates in China, which would be useful for researchers and instructors in medical education. Determining the fundamental content of a donation-related curriculum is an indispensable step for implementation of organ donation education and promotion of organ donation.

Multicentric Study to Evaluate Mexican Medical Students' Knowledge of Transplants and Organ Donation.

INTRODUCTION: Transplants and organ donation are greatly aided by future medical professionals having adequate knowledge of this topic. This study aimed to elucidate the level of Mexican medical students' knowledge in the field of transplants and organ donation. MATERIALS AND METHODS: The evaluation instrument was designed and validated. The design used simple sampling with replacement, selecting a random sample of 5 universities from among the institutional members of the Mexican Association of Departments and Schools of Medicine (Asociación Mexicana de Facultades y Escuelas de Medicina [AMFEM]). The sample was composed of 3214 medical students. Measures of central tendency were determined, and the mean scores obtained across the different universities were compared using a Kruskal-Wallis test. The odds ratio was calculated for the students whose school or department included instruction on transplants and donation within their curriculum. Kendall correlation was used for the students' academic grade level and score. All analyses considered a threshold of P < .05. RESULTS: A questionnaire was administered to a sample of 2563 students to evaluate their knowledge of transplants and organ donation. The average score was 4.02 on a scale of 0 to 10 (standard deviation 0.03), with a 95% confidence interval (3.96-4.08). Students whose school or department taught the subject of transplants and donations within their curriculum obtained an odds ratio of 1.44 (P = .0000822). CONCLUSIONS: The findings of this study suggest that medical students in Mexico do not have sufficient knowledge of transplants and organ donation.

Information About Donation and Organ Transplantation Among Spanish Medical Students.

INTRODUCTION: Health professionals are asked to promote health, especially organ transplantation; however, they do not always have specific training. OBJECTIVE: To analyze information about donation and organ transplantation among Spanish medical students. METHOD: The population under study is medical students in Spanish universities using the database of the International Donor Collaborative Project, stratified by geographic area and academic year (n = 9275). The instrument used is the attitude questionnaire for organ donation for "PCID-DTO-Ríos" transplantation, validated with an explained variance of 63.203% and α = 0.834. The Student t test was applied together with the χ2 test, complemented by an analysis of the remainders, and Fisher's exact test was applied. RESULTS: Of the students, 74% indicate that they have received information from university professors about organ transplant. Concerning specific issues with the donation, it is notable that only 66.7% (n = 6190) know and accept the concept of brain death as the death of a person. However, only 22% consider themselves as having good information, and 35.3% indicate that their information is scarce or void. Students indicate having received information about transplant from other extra-university sources, such as television and Internet (80.9%), books and magazines (73.2%), and the press (66.9%). From the information obtained in the sociofamilial field, 60.7% have obtained information from the family and 58.1% from friends. Of this information, 9% has been negative from friends, 7.5% from family, 6% from the Internet and television, and 4% from university professors. CONCLUSION: Spanish medical students believe they have little information about organ transplantation and have received negative information.

Stakeholder perspectives of the clinical utility of pharmacogenomic testing in solid organ transplantation.

Aims: To assess stakeholder perspectives regarding the clinical utility of pharmacogenomic (PGx) testing following kidney, liver, and heart transplantation. Methods: We conducted individual semi-structured interviews and focus groups with kidney, liver, and heart transplantation patients and providers. We analyzed the qualitative data to identify salient themes. Results: The study enrolled 36 patients and 24 providers. Patients lacked an understanding about PGx, but expressed interest in PGx testing. Providers expressed willingness to use PGx testing, but reported barriers to implementation, such as lack of knowledge, lack of evidence demonstrating clinical utility, and patient healthcare burden. Conclusion: Patient and provider educational efforts, including foundational knowledge, clinical evidence, and applications to patient care beyond just immunosuppression, may be useful to facilitate the use of PGx testing in transplant medicine.

Continuing Training Accreditation in the Organ Donation Process in Andalusia: Results From the Education and Training Unit of the Regional Transplant Organization of Andalusia.

OBJECTIVE: The objective of this study is to evaluate the results obtained by the Training Unit of the Regional Transplant Organization of Andalusia from 2015 to 2017. METHODS: The following indicators were analyzed: number of activities carried out, number of students trained per year, students who do not complete the course, student and teacher satisfaction, learning assessment via postformation test, and transfer of training to the workplace. RESULTS: Between the years 2015 to 2017, 86 courses were carried out, and 2600 students were trained (1325 doctors, 1064 nurses, and 211 students with other degrees). A total of 83 students (3.2%) withdrew from training after its initiation. The overall assessments from teachers and students were 95/100 and 92/100, respectively. Student scores from the postformation test to assess learning averaged 77 points. CONCLUSION: It is worth noting the elevated number of courses offered and students trained over this 3-year period. We believe this has had a strong impact on the donation rate in Andalusia, which rose from 37.5 donors per million inhabitants in 2014 to 52.5 donors in 2018. Although student and teacher satisfaction was very high, it is clear that the transfer of new skills to the workplace could benefit from improvements in teamwork, communication with the transplant coordinator, the overall work environment, and the resources at their disposal.

Specific Needs of Medical Students for Organ Donation Courses: A Qualitative Study in China.

BACKGROUND: Global promotion of organ transplantation is contingent upon continuous improvement of the donation rate. Organ donation education is an important measure for changing public awareness and promoting organ donation. Therefore, it is important and urgent to conduct a systematic study of the organ donation courses offered in China and around the world. The aim of this study was to learn the views and needs of Chinese medical students and provide a reference for international peers. METHODS: Semistructured, in-depth interviews and purposive sampling were used in this study. A total of 18 university students majoring in medicine and nursing were selected according to the principle of data saturation and interviewed. The data were sorted and analyzed with phenomenology. RESULTS: These interviewees generally agreed that an organ donation course should be offered. They were in urgent need of knowledge regarding organ donation procedures and relevant policies and eager for a practical and experience-based teaching method design. The Chinese medical students surveyed also believed that the course should also be available to clinical practitioners, nonmedical students, and the public. CONCLUSION: Medical students' demand for an organ donation course should be considered. To fully stimulate their interest in learning and to provide support and a guarantee for continuous improvement of transplant operations promotion and donation rate worldwide, specific organ donation courses and flexible training should be created.

Effectiveness of the Gerundium Youth Educating Program in Hungary.

The acceptance of brain death and the legitimation of organ transplantation is very much dependent on the general knowledge of the society. In Hungary, the legislation of brain death is based on presumed consent. There is no structural education about the topic so far. AIM: The role of the Gerundium program is to educate high school students about the importance of transplantation and the meaning of brain death. The goal of this study was to evaluate the effectiveness of the Gerundium contemporary educational program in a pilot study. METHOD: The education was held by medical students who successfully completed a preparatory elective course consisting of relevant information in the topic. Medical students used simple language during the 45-minute presentations. Two tests with simple but representative questions created by experts were completed by high school students: one directly before contemporary education and another 5 to 6 weeks after the lecture. RESULTS: A total of 147 tests were completed: 78 before and 69 after the presentation in the city of Debrecen and 294 before the lecture in the city of Gyor. In Debrecen, the overall correct answers increased by 6.05% (P < .05; before vs after). The results show that the knowledge transfer is highly effective in this manner and the students know significantly more weeks after the lectures. CONCLUSION: There is much to do to broadly inform society about transplantation and brain death, but we will continue to increase the number of students and measure the dynamic change of the students' knowledge.

Análise epidemiológica dos candidatos à doação de órgãos nos estados do Ceará, São Paulo e Acre / Epidemiological analysis of candidates for the donation of organs in the states of Ceará, São Paulo and Acre / Análisis epidemiológica de los candidatos a la donación de órganos en los estados del Ceará, São Paulo y Acre

Objetivo: Analisar aspectos epidemiológicos de candidatos a doação de órgãos do Ceará, comparando com os estados de melhor e pior desempenho quanto ao transplante. Método: Estudo Transversal descritivo com abordagem quantitativa realizado com dados do Registro Brasileiro de Transplantes publicados em 2016. Resultados: O pior e melhor estado em relação às doações de órgãos foram Acre e São Paulo, respectivamente. O número de doadores efetivos por milhão de população no Ceará foi superior ao de São Paulo. A recusa familiar representou a maioria das causas de não concretização dos transplantes nos três estados. O Acidente Vascular Cerebral foi a principal causa de morte em São Paulo e Acre, enquanto no Ceará foi o Traumatismo crânio encefálico. Ceará e Acre apresentaram faixa etária predominante de 18-34 anos. Conclusão: O desempenho do Ceará quando comparado com os outros estados foi superior em relação a transformação de potenciais doadores em doadores efetivos

Objective: To analyze the epidemiological aspects of candidates for donation of organs from Ceará, comparing them with the best and worst performing states regarding transplantation. Methods: A descriptive cross-sectional study with a quantitative approach was performed with data from the Brazilian Transplant Registry published in 2016. Results: The worst and best condition in relation to organ donations were Acre and São Paulo, respectively. The number of effective donors per million population in Ceará was higher than in São Paulo. Family refusal accounted for most of the causes of non-transplantation in the three states. Cerebral Vascular Accident was the main cause of death in São Paulo and Acre, while in Ceará it was traumatic brain injury. Ceará and Acre had a predominant age group of 18-34 years. Conclusion: The performance of Ceará when compared to the other states was higher in relation to the transformation of potential donors into effective donors

Objetivo: Analizar aspectos epidemiológicos de candidatos a la donación de órganos de Ceará, comparando con los estados de mejor y peor desempeño en cuanto al trasplante. Métodos: Estudio Transversal descriptivo con abordaje cuantitativo realizado con datos del Registro Brasileño de Trasplantes publicados en 2016. Resultados: El peor y mejor estado en relación a las donaciones de órganos fueron Acre y São Paulo, respectivamente. El número de donantes efectivos por millón de población en Ceará fue superior al de São Paulo. La negativa familiar representó la mayoría de las causas de no concreción de los trasplantes en los tres estados. El Accidente Vascular Cerebral fue la principal causa de muerte en São Paulo y Acre, mientras que en Ceará fue el Traumatismo cráneo encefálico. Ceará y Acre presentaron rango de edad predominante de 18- 34 años. Conclusión: El desempeño de Ceará cuando comparado con los otros estados fue superior en relación a la transformación de potenciales donantes en donantes efectivos

A Community-Based Study of Giving ACTS: Organ Donation Education for African American Adults.

BACKGROUND: Transplantation continues to be the therapy of choice for people experiencing end-stage organ failure. African Americans (AAs) are overrepresented among those awaiting an available organ for the purpose of a transplant, yet donate at rates lower than other races due to a list of well-studied barriers. The Giving ACTS (About Choices in Transplantation and Sharing) Intervention was developed to provide culturally appropriate messaging to AAs about organ and tissue donation and transplantation (OTDT). The purpose of this community-based study was to test the extent to which the intervention was effective in (1) improving donation-related knowledge and attitudes among AA participants, and (2) increasing registration on the state donor registry. METHODS: Using a single-group, pre-post design, 1,585 participants received the intervention in small groups hosted in community settings. RESULTS: From baseline to immediate follow-up, participants significantly increased in OTDT-related knowledge, beliefs and attitudes, endorsement of the positive consequences of donation, and willingness to donate (all ps < .001). Participants' beliefs about the negative consequences of organ and tissue donation, however, did not significantly change, and registration on the state donor registry was negligible (1.3%). CONCLUSION: Results suggest that Giving ACTS was generally successful in improving attitudes and beliefs; the intervention, however, was not effective in changing participants' beliefs about the negative consequences of OTDT, or increasing actual registration behaviors. Future studies in this area should be conducted to empirically evaluate the role of distrust in healthcare systems among AAs and its possible mediating effect on the relationship between donation-related education and the desired health behaviors.

A New Measure of Health Numeracy: Brief Medical Numbers Test (BMNT).

BACKGROUND: Approximately half of Americans have inadequate health literacy, which leads to poorer health outcomes. Health numeracy is an important component of literacy, which reflects one's ability to understand and manipulate numbers. This is especially important for transplant candidates, as adherence to medical recommendations is essential for posttransplant care. Although validated measures of numeracy exist, they can be inconvenient and time consuming to administer. OBJECTIVE: The Brief Medical Numbers Test (BMNT) was created in 2011 to quickly assess the health numeracy of a patient during presurgical psychiatric transplant evaluations. The purpose of this study was to evaluate the reliability and validity of the BMNT for this use via retrospective chart review. METHODS: There were 293 patients referred over a 2-year period for a presurgical psychiatric evaluation. The evaluation consisted of a semistructured interview and completion of several measures, including the BMNT, a measure of health literacy, and a brief test of cognitive functioning. RESULTS: The BMNT had acceptable internal consistency (α = .71), convergent validity with health literacy and cognitive functioning, and predictive validity with surgical outcomes. CONCLUSIONS: Preliminary data suggests the BMNT is a reliable and valid measure of health numeracy in patients being evaluated for transplant.

Using technology to enhance medication regimen education after solid organ transplantation.

PURPOSE: The design and implementation of a tool that combines clinical teaching with cutting-edge, simplified technology for providing medication education to solid organ transplant (SOT) recipients are described. METHODS: In a retrospective study of adults who received kidney transplants from February 2015 through May 2017, patients were educated about their medications using a tablet computer application, Medication Regimen Education (MRxEd), that presented concise videos describing the name, indication, dose, adverse effects, and associated interactions of all medications received, as well as special considerations applicable to each agent. Assessment questions were used to reinforce key concepts and identify knowledge gaps. RESULTS: The digital educational intervention was provided to 282 kidney transplant recipients. Patients were predominantly white (48%) and/or male (63%), with a median age of 51 years (interquartile range, 37-61 years). Patients came from a variety of education backgrounds. Most patients (81%) were educated on dual maintenance immunosuppression (with tacrolimus and mycophenolate) and 3 infection prophylaxis agents (nystatin, sulfamethoxazole-trimethoprim, and valganciclovir). Most patients (90%) correctly answered questions related to medication indications, dosing, and special rules, but many (61%) had difficulty correctly answering questions about adverse effects. CONCLUSION: An innovative approach for interactive and engaging medication teaching with the MRxEd application enhanced the education process for SOT recipients.

Using an informatics education strategy to resolve the dilemma of teaching transplantation in medical institutions: Multidisciplinary medical team perspectives.

In Taiwan, the current survival rate 1 year after transplantation exceeds 80%. However, the number of organ/tissue donors per year in Taiwan is extremely low, resulting in increased mortality. This is also true in Europe and in the United States. Recently, data from the Taiwan Organ Registry and Sharing Center showed that, although fundraising for organs/tissues slightly increased, the number of donors did not exhibit a corresponding growth trend. Identifying appropriate donors and the provision of good quality transplantation care by medical team members are current challenges. Hence, the application of information technology to in-service education for organ transplantation professionals has been suggested.This was a qualitative study that employed qualitative content analysis with purposive and snowball sampling. The study participants (n = 8, mean age 39.88 ±â€Š3.06 years) included medical staff involved in tissue/organ transplantation from 4 leading medical centers and 3 regional teaching hospitals, and those who participated in the informatics education system.The interviewees from multidisciplinary medical teams showed the status of and dilemma in organ fundraising/donation/transplantation, noting 6 core themes. Regarding relevant education and training, 4 core themes were identified.Current educational courses for organ fundraising/donation/transplantation are inadequate and seem to provide insufficient information to multidisciplinary medical teams. Hence, it is necessary to develop a theoretical construct to create a complete curriculum framework and to establish complete fit-in professional and ethical organ transplantation learning programs based on informatics technology to increase the interdisciplinary exchange of experience.

Accessibility and Content of Abdominal Transplant Fellowship Program Websites in the United States.

OBJECTIVES: Organ transplant volume is at an all-time high. Prospective applicants often utilize individual programs' websites for information when deciding if and where to apply for fellowship training. Accessibility and content from one program's website to the next is highly variable and may contribute to the selection of programs. The aim of this study was to evaluate the accessibility and content of abdominal transplant surgery fellowship websites. MATERIALS AND METHODS: The American Society of Transplant Surgeons (ASTS) website provides a complete list of abdominal transplant fellowship programs in the United States. A Google search was performed to determine the presence and accessibility of a program's website. Available websites were evaluated on the presence of 20 content criteria. RESULTS: Sixty-five programs in the United States were identified using the ASTS directory. Websites for fifty-one (78%) fellowship programs were identified. Three-fourths of websites contained 50% or less of the 20 evaluated data points, whereas 24% of websites contained 5 or less criteria. The most and least included data points were program description (100%) and on-call expectations (10%), respectively. CONCLUSIONS: The accessibility and content of a program's website is one major factor that can influence a potential applicant's decision on where to pursue transplant surgery fellowship training. This study revealed that a significant percentage of programs fail to provide a functional website. Of the fifty-one programs that did have websites, information deemed important to prospective applicants may be considered inadequate.