Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction.

Introduction Delivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance. Methods Previous OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the "do's and don'ts" of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges' g was used to assess mean scores and effect size. Results A total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges' g was 0.37 (95% CI: -0.59 to 1.33). Conclusion Residents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.

Developing Dietetic Students' Confidence in Multicultural Communication through Flipped Learning.

Problem: In a Master of Dietetics program, cultural competence was originally taught with lectures of cultural food practices. Course evaluations reflected that students wanted more opportunities to practice multicultural communication skills whereas lecturers felt that students' personal inquiry of cultural competence could be strengthened. This study explores whether the combination of self-directed pre-class learning and in-class activities through flipped learning could address these instructional issues. Three research questions were examined: (1) How did dietetic students' perceived confidence in multicultural communication change before and after undergoing flipped learning? (2) Which aspects of cultural competence influenced students' confidence in multicultural communication before and after flipped learning? (3) Which aspects of cultural competence were students' cultural learning goals based upon after flipped learning? Intervention: The intervention began with an introductory lesson in which students attended a lecture on New Zealand's cultural landscape, self-assessed their cultural influences, and completed self-directed learning of cultural competence concepts. After this, students participated in two flipped learning lessons; the first lesson focused on cultural knowledge and the second on multicultural communication skills. For both lessons, students completed preparatory activities before engaging in small-group activities during the class sessions. Before and after the flipped learning lessons, students wrote online reflections about the reasons underlying their confidence in multicultural communication. Context: The intervention was carried out with 32 early dietetic students who were in their first semester of postgraduate studies and 31 students consented to study participation. The majority of study participants were female (n = 30, 97%), European or Asian (n = 28, 91%), and between 21-30 years old (n = 27, 87%). Impact: Pre and post module surveys submitted by 31 students showed that more of them reported being confident or very confident in multicultural communication after flipped learning. Reflections submitted by 31 students before flipped learning showed that their confidence in multicultural communication was based upon their cultural knowledge and cultural interaction experiences. Reflections submitted by 19 students after flipped learning indicated that they developed cultural skill which helped them become confident in multicultural communication. These students set goals to continue developing their cultural knowledge, engaging in cultural interaction, and optimizing opportunities for applying cultural skill during clinical practice. Lessons learned: The study results showed that flipped learning can be used for cultural learning. As compared to lectures, flipped learning can provide students with more authentic contexts to practice multicultural communication. These learning experiences model how students might continue to self-direct their cultural competence development throughout their professional practice.

Implementation of technician-driven medication therapy management program in community pharmacies.

OBJECTIVES: Pharmacists have reported barriers in implementing medication therapy management (MTM) services into community pharmacy workflow. A community pharmacy grocery chain created an MTM training program with detailed workflow manual and templates intended as a turnkey operation for MTM implementation. To expand the use of this program, 20 community pharmacies were trained in January 2017. The objective of this study was to evaluate the adoption or actual implementation of the program's workflow and to determine barriers to implementation. SETTING: Pharmacists and technicians who participated in the program were from 20 community pharmacies, including a chain pharmacy, multiple-independent pharmacies, and single-independent pharmacies, in Arkansas. PRACTICE INNOVATION: The training program used a standardized process with documentation templates to implement a technician-driven workflow. The program required 1 pharmacist and 1 technician per pharmacy to attend an 8-hour live training session. EVALUATION: Qualitative cross-sectional study using semistructured interviews with pharmacists and technicians 1 year after training session. One pharmacist and 1 technician from 12 pharmacies were invited. The interview guide included questions on how the program was implemented at their respective pharmacies and barriers to implementing the program. The interviews were recorded and transcribed, and transcripts were coded for common themes. RESULTS: Seven pharmacists and 6 pharmacy technicians agreed to participate. The program was implemented without difficulty in all 7 pharmacies. Pharmacists and technicians reported that the program provided streamlined MTM workflow, expanded technicians' role, and improved confidence in providing services. Barriers to providing MTM services, despite the new workflow, included competing priorities and staffing. CONCLUSION: The training program resulted in a variety of community pharmacies to successfully implement MTM services. Future studies should further explore sustainability and impact on financial and patient outcomes.

Dynamic response due to behind helmet blunt trauma measured with a human head surrogate.

A Human Head Surrogate has been developed for use in behind helmet blunt trauma experiments. This human head surrogate fills the void between Post-Mortem Human Subject testing (with biofidelity but handling restrictions) and commercial ballistic head forms (with no biofidelity but ease of use). This unique human head surrogate is based on refreshed human craniums and surrogate materials representing human head soft tissues such as the skin, dura, and brain. A methodology for refreshing the craniums is developed and verified through material testing. A test methodology utilizing these unique human head surrogates is also developed and then demonstrated in a series of experiments in which non-perforating ballistic impact of combat helmets is performed with and without supplemental ceramic appliques for protecting against larger caliber threats. Sensors embedded in the human head surrogates allow for direct measurement of intracranial pressure, cranial strain, and head and helmet acceleration. Over seventy (70) fully instrumented experiments have been executed using this unique surrogate. Examples of the data collected are presented. Based on these series of tests, the Southwest Research Institute (SwRI) Human Head Surrogate has demonstrated great potential for providing insights in to injury mechanics resulting from non-perforating ballistic impact on combat helmets, and directly supports behind helmet blunt trauma studies.

Text-to-speech technology effects on reading rate and comprehension by adults with traumatic brain injury.

OBJECTIVE: This study's purpose was to examine the comprehension, rate and perceptions and reading preferences of adults with severe traumatic brain injury (TBI) when reading passages with and without computerized text-to-speech (TTS) support. DESIGN AND METHODS: Nine adults with severe TBI read 24 passages in two conditions: with and without TTS support. The researchers compared reading rate and comprehension accuracy across conditions. Also, participants rated their perceived performance and reading preferences via a follow-up questionnaire. RESULTS: Comparison to normative data revealed that all nine participants read slower than average neurotypical readers. As a group, participants read significantly faster with TTS support than without such support, even though the TTS reading rate was roughly comparable to the oral rather than silent reading rate of neurotypical adults. No significant differences in comprehension resulted between the two conditions. Over half of the participants preferred the TTS condition over the no-TTS condition. In general, participants were inaccurate in judging their relative reading rates and comprehension accuracy across conditions. CONCLUSIONS: TTS may improve reading efficiency without compromising reading comprehension accuracy for adults with TBI. Given this finding, some survivors may find use of TTS technology contributes to increased participation in and efficiency when performing reading activities.