Collaborative clinical reasoning: a scoping review.

Background: Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. Methods: A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. Results: A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. Conclusions: While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.

An Investigation of Patient Preferences and Gender Dynamics of Neurosurgeon Selection in Taiwan: A Mixed-Method Study.

OBJECTIVE: To investigate the influence of gender on patient preferences during the selection of neurosurgeons. METHODS: A mixed-method, cross-sectional study was conducted at Linkou Chang Gung Memorial Hospital in Taiwan, involving 60 patients. The study encompassed both structured questionnaires and in-depth interviews, administered postpatient-surgeon interactions to assess the nuanced effect of surgeon gender on patient choice. A balanced representation of both genders was ensured among the neurosurgeons involved. Thematic analysis was employed for textual data, while numeric data were analyzed using descriptive and Chi-square statistics. RESULTS: The majority of participants (n = 40, 66.7%) expressed no preference regarding the gender of their neurosurgeon during outpatient consultations. Nonetheless, a notable fraction, predominantly female, preferred female neurosurgeons (n = 20, 33.3%). Statistical analysis highlighted a significant correlation between the gender of the patients and their preferred neurosurgeon's gender, with female patients predominantly favouring female neurosurgeons (P < 0.05). Qualitative insights indicate that, although professional skill and experience are primary factors in selecting a neurosurgeon, a latent gender preference exists, influenced by perceived privacy, empathetic care, and the surgical finesse associated with female neurosurgeons. CONCLUSIONS: Although expertise and professionalism are of paramount importance, there is a clear preference for female neurosurgeons, especially among female patients. These findings underscore the importance of recognizing and accommodating patients' preferences to ensure neurosurgical care aligns with patient comfort, expectations, and the broader movement towards gender equality.

COVID-19-related stress among emergency physicians: a scoping review protocol on the stressors and coping strategies.

OBJECTIVE: This scoping review aims to identify the COVID-19-related stressors and the corresponding coping strategies among emergency physicians during and following the pandemic. INTRODUCTION: In the midst of an unprecedented COVID-19 crisis, healthcare professionals confront a diverse set of difficulties. Emergency physicians are under immense pressure. They must provide frontline care and make quick decisions in a high-pressure environment. This can lead to a variety of physical and psychological stressors, including extended working hours, increased workload, personal risk of infection and the emotional toll of caring for infected patients. It is critical that they be informed of the numerous stressors they face, as well as the various coping methods accessible to them, in order to deal with these pressures. INCLUSION CRITERIA: This paper will summarise the findings of primary or secondary investigations on emergency physicians' stressors and coping strategies during and following the COVID-19 epidemic. All journals and grey literature in English and Mandarin published after January 2020 are eligible. METHODS: The Joanna Briggs Institute (JBI) method will be used to conduct the scoping review. A thorough literature search will be performed on OVID Medline, Scopus and Web of Science to find eligible studies, using the keywords related to emergency physicians, stress and coping strategies. Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study quality. A narrative overview of the findings from included studies will be given. ETHICS AND DISSEMINATION: This review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.

Does seniority always correlate with simulated intubation performance? Comparing endotracheal intubation performance across medical students, residents, and physicians using a high-fidelity simulator.

BACKGROUND: Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. METHODS: We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. RESULTS: There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. DISCUSSION: Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. CONCLUSION: Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians' knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.

Point-of-Care Ultrasound May Reduce Misdiagnosis of Pediatric Intussusception.

Aim: Intussusception, the most common abdominal emergency in early childhood, is frequently misdiagnosed at initial presentation. The effect of using point-of-care ultrasonography (POCUS) by emergency medicine physicians on pediatric intussusception misdiagnosis rate remains unclear. Here, we summarize outcomes and misdiagnoses before and after training junior and senior physicians on using POCUS for diagnosing intussusception and compared their performance levels. Materials and Methods: This observational cohort analysis included patients with suspected intussusception who visited a pediatric emergency department (ED) between January 2017 and December 2019. All enrolled patients were evaluated by junior (<10-year experience) or senior attending physicians. Misdiagnosis was defined as a finding of negative air reduction or confirmation of diagnosis on ED revisit or admission. The misdiagnosis rates and outcomes before and after POCUS training for intussusception diagnosis were evaluated and performance of the junior and senior physicians was compared. Results: Of the 167 enrolled patients, 130 were confirmed to have intussusception by air reduction. Misdiagnosis rate was significantly lower in the post-training patient group after training than in the pre-training patient group (43.7 vs. 12.7%, P < 0.001). After training, fewer misdiagnoses were made by the junior (59.1 vs. 25.9%, P = 0.003) and senior (31.7 vs. 0%, P < 0.001) physicians. In the post-training patient group, the door-to-reduction time and rate of ultrasonography consultation with an expert also decreased significantly (118.2 ± 124.5 vs. 198 ± 250.2 min, P = 0.006). Abdominal pain (80.9%) was the most common symptom of intussusception, followed by vomiting (58.3%), fever (17.8%), bloody stool (15.4%), and diarrhea (14.2%). Even after training, the presenting symptoms of intussusception often leading junior physicians to misdiagnosis were diarrhea and fever. Conclusions: A brief POCUS training leads to decreased misdiagnosis rates in both the senior and junior physicians. Junior physicians should increase their awareness regarding diarrhea and fever being the presenting symptoms of intussusception, particularly in early childhood. Combining clinical judgment and POCUS results forms the core principle of the evaluation of children with intussusception.

Differing viewpoints around healthcare professions' education research priorities: A Q-methodology approach.

Recently, due to scarce resources and the need to provide an evidence-base for healthcare professions' education (HPE), HPE research centres internationally have turned to identifying priorities for their research efforts. Engaging a range of stakeholders in research priority setting exercises has been posited as one way to address the issues around reducing researcher bias and increasing social accountability. However, assigning individuals to single a priori stakeholder groups is complex, with previous research overlooking cross-category membership and agreement between individuals across groups. Further, analyses have pitched stakeholder groups against one another in an attempt to understand who prioritises what, and often fails to grasp rationales underlying priorities. A deeper understanding of who prioritises what research areas and why is required to consider applicability of results across contexts and deepen social accountability and transferability. A web-based Q-methodological approach with n=91 participants (who) from ten pre-classified stakeholder groups was employed with post-sort interviews (why). Sixty-seven Q-set items (Chinese/English languages) were developed from previous research (what). Participants were mainly from Taiwan, although international researchers were included. Q-sorting was undertaken in groups or individually, followed by post-sort interviews. Eighty-six participants' Q-sorts were included in the final analysis. Intercorrelations among Q-sorts were factor-analysed (Centroid method) and rotated analytically (Varimax method). Interviews were thematically analysed. Six Viewpoints with eigenvalues exceeding 1 were identified (range = 3.55-10.34; 42% total variance; 35/67 topics), mapping high/low priorities for research foci: Workplace teaching and learning; Patient dignity and healthcare safety; Professionalism and healthcare professionals' development; Medical ethics and moral development; Healthcare professionals' retention and success; Preparing for clinical practice. Eighteen rationales for prioritisation were identified: impact, organisational culture and deficit of educators/practitioners were most highly cited. Each Viewpoint, held by multiple stakeholders, comprised a unique set of topic-groupings, target study participants, beneficiaries and rationales. The two most prolific Viewpoints represent how different stakeholder groups highlight key complementary perspectives of healthcare professions' education in the workplace (efficacy of teaching/learning practices, application of knowledge/values). By illuminating the detail around each Viewpoint, and presenting an holistic description of the who-what-why in research priority setting, others wishing to undertake such an exercise can more easily identify how stakeholder Viewpoints and their epistemic beliefs can help shape healthcare professions' research agendas more generally.

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018.

BACKGROUND: Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. METHODS: This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. RESULTS: From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by - 0.15 (95% CI - 0.18 to - 0.11) per year (Pearson's R = - 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer-Lemeshow test p < 0.001). CONCLUSIONS: Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.

Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries.

PURPOSE: The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data. METHODS: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing. RESULTS: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data. CONCLUSIONS: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

A scoping review examining funding trends in health care professions education research from Taiwan (2006-2017).

BACKGROUND: Traditionally health care professions education research (HCPER) is poorly funded, despite it being key to success. PURPOSE: This unique study maps HCPER evolution within a single country during a period when significant national governmental HCPER funding is introduced. METHODS: A scoping review method examined Taiwan's HCPER landscape across 12-years. Literature searches across four databases (OVID Medline; Scopus; Web of Science; the Airiti Library), a manual scan of HCPE journals and hand searches. Endnote and ATLAS.ti managed the data. Demographic and content codes were developed. PRISMA guidelines are used. DISCUSSION: One thousand four hundred and ten articles across 310 journals, with a steady rise in funded studies. Science/Social Science Citation Index and English language publications increased. Nursing Students/Nurses and Medical Students/Physicians are the most common populations. Significant associations with funding was found for indexed and English language publications. National funding influenced quality and local funding positively. CONCLUSION: Caution around local vs. global needs is highlighted and national funding policies for HCPER are advocated.