Improving CRNAs' Confidence and Perceived Knowledge of Endosurgical Patients Who Use Marijuana: A Quality Improvement Project.

Although some researchers have reported health-related benefits of marijuana, others have reported adverse side effects in nearly every organ system. Patterns of marijuana use are evolving, as is researchers' understanding of marijuana use for healthcare. Despite these findings and developments, nurse anesthetists are inadequately educated about marijuana's perioperative effects on endosurgical patients. As a result, many nurse anesthetists lack confidence in and knowledge of the perioperative care of endosurgical patients under the influence of marijuana. This lack of confidence and knowledge limits the ability of nurse anesthetists to provide optimal care, threatens patient safety, and potentially impairs surgical outcomes. To improve the confidence and perceived knowledge of certified registered nurse anesthetists (CRNAs) regarding perioperative care of endosurgical patients who use marijuana, a quality improvement project was conducted in a metropolitan endosurgical center in California. After the project, participating CRNAs (N = 15) reported increased confidence (z = -0.982; P = .325, > .05) and significantly improved perceived knowledge (z = -3.04; P = .002, < .05) regarding care of patients who use marijuana. For endosurgical patients who used marijuana prior to their procedure, knowledgeable and confident anesthesia care for the side effects of marijuana substantially improved the quality of care, communication, and reduced cancellations.

Self-Efficacy and Multisite Pain Predictors among Economically Disadvantaged Women with Back Pain.

BACKGROUND: Chronic low back pain (CLBP) prevalence is higher among women and those with low socioeconomic status. Without adequate self-efficacy and subsequent self-management, patients gradually develop chronic multisite pain after one year of having CLBP alone. AIM: This study investigated the predictors of self-efficacy and multisite pain among adult, economically disadvantaged women, where pain prevalence is higher. DESIGN: Cross-sectional, descriptive study. SETTING: Pain management center. SUBJECTS: Participants (n = 50) with primary diagnosis of chronic low back pain. METHODS: After Institutional Review Board approval, data collection was conducted using valid and reliable instruments measuring several variables. Controlling for age and race, multiple linear regression was used for analyses. RESULTS AND CONCLUSIONS: For all predictors of self-efficacy, a significant regression equation was identified (p < .01) with R2 of .413 and variance of .643. Pain catastrophizing was a significant individual predictor (p < .05). A significant regression equation was also found for all predictors of multisite pain (p < .001) with R2 of .528 and variance of .726. Individual predictors (p < .05) were age, physical function, and numbers of pain treatments and chronic medical conditions. Study findings suggest that significant predictors can be key to advancing pain research, education, practice, and healthcare policy toward improving pain management. Particularly among this population, pain catastrophizing needs to be targeted in pain management. To minimize development of multisite pain, further investigation of identified predictors including number of chronic medical conditions and pain treatments received are necessary. Multimodal, but targeted approaches addressing these predictors are recommended, instead of costly, indiscriminate multimodal therapy. Targeted interventions can help reduce pain care disparities among socioeconomically disadvantaged women, identify high risk groups for prompt intervention, facilitate better pain response to treatments, and minimize further disability.

A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills.

OBJECTIVE: To assess the acquisition and retention of screening ophthalmic clinical skills over 3 years of medical school. DESIGN: Observational, longitudinal, multiple skills measures. PARTICIPANTS: All 96 students enrolled in a single graduating class at a public medical school in California. METHODS: Immediately after the second-year ophthalmic clinical skills course, all students were evaluated by their preceptors and self-rated for competence in defined skills. Follow-up assessments were done during 2 required third-year clerkships without additional formal ophthalmic clinical exposure. Three complete history and physical examination chart notes routinely submitted for course grading in third-year clerkships were selected randomly for each student by clerkship directors in family medicine and internal medicine, masked for identity, and then scored for appropriateness. Funduscopic skills were assessed objectively with a simulator in the third-year Clinical Performance Examination. During a fourth-year 4-day ophthalmology clerkship, students were trained and reassessed with the same simulator. Just before graduation, a self-assessment questionnaire was administered to the entire class. MAIN OUTCOMES MEASURES: Twelve skills were assessed: ability to evaluate visual acuity (VA); pupils; extraocular muscles; confrontation fields; lids; cornea; conjunctiva/sclera; anterior chamber depth; and, funduscopically, the disc, macula, vessels, and retina. RESULTS: Faculty rated 88% to 90% of students as able to assess acuity, pupils, ductions, and fields, and 72% to 82% as able to visualize various parts of the fundus. Seventy-six percent of students felt comfortable after funduscopic training. In 364 analyzed chart notes, one VA was measured, and pupils were examined in 66% of notes, ductions in 54%, and fields in 3%. Only 11% of notes documented attempted funduscopy; <2% suggested actual visualization. In the Clinical Performance Examination, 32% of students accurately described some aspect of the disc, with an improvement to 84% of 38 students retested after brief ophthalmology training in year 4. Of 54 (56%) respondents to the exit questionnaire, 59% felt comfortable visualizing some aspect of the fundus. CONCLUSIONS: There is worrisome erosion of students' acquired screening skills across the third-year clerkships. Skill reinforcement in the fourth year yielded improved performance. Attention must be directed to reinforcing basic ophthalmology skills training within medical school curricula to assure competence of graduates.

Just a spoonful of humanities makes the medicine go down: introducing literature into a family medicine clerkship.

BACKGROUND: This project introduced medicine-related poetry and prose to a Year 3 family medicine clerkship with the purpose of determining students' perception of the usefulness of such materials to enhance empathy, improve patient management, and reduce stress. Although humanities are represented in the curricula of many medical schools, we need more information on how best to incorporate them during the clinical years. METHOD: In 2000, we used a needs assessment survey to identify learner perceptions of medical humanities. Using this information, in 2001-03 we developed and implemented a humanities-based curriculum consisting of readings linked to clinical vignettes, comments about humanities reading in required clinical Subjective, Objective, Assessment, Plan (SOAP) notes, and either station-specific or general poetry accompanying student end-of-clerkship objective structured clinical examinations. We collected both quantitative and qualitative data assessing student reactions and examined the data using non-parametric statistics and content analysis, respectively. RESULTS: Students showed moderate interest in incorporating humanities in medical education as a way of enhancing empathy, improving understanding and reducing frustration. Assessment of the clerkship humanities curriculum suggested a positive influence on students in terms of empathy for the patient's perspective, and a lesser, but still positive, impact on patient management. DISCUSSION: Responses from this group of learners suggest that there is receptivity toward introducing medical humanities into family medicine curricular venues and that such effort can have a generally positive effect on learner empathy, awareness and understanding toward patients and doctors.