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1.
J Infect Dev Ctries ; 14(9): 943-952, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031078

RESUMO

INTRODUCTION: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. This study determined the level of knowledge, attitude, practices, and impact of COVID-19 infection on healthcare workers (HCWs) working in a South-Eastern Nigerian state. METHODOLOGY: This was a web-based, cross-sectional study conducted among healthcare workers in South-eastern, Nigeria during the lockdown period. Socio-demographic profile, knowledge of COVID-19, fears and impact concerning COVID-19, attitude of health workers to work, preventive practices during this pandemic period were obtained. Data were analysed using STATA 16.0. Chi-square and Fisher's exact tests of association were used to determine the association between variables, with the significance level set at p < 0.05. RESULTS: A total of 403 health care workers participated in the study. Majority of participants (n = 357, 88.59%) had good knowledge and good preventive practices (n = 328, 81.39%) of COVID-19. A significant proportion of respondents had a poor attitude to work (n = 101, 25.06%) and an attitude of indifference (n = 233, 57.82%). Almost half (48.64%) of participants had been negatively affected by COVID-19. Knowledge significantly influenced practice (p = 0.029). Lack of Personal protective equipment, fear of dying and going to common places, had a significant impact on the attitude of workers. CONCLUSION: Good knowledge which influenced practice, high use of preventive practices, with associated poor and indifferent attitude was noted among healthcare workers. Fear of death and lack of personal protective equipment had a strong impact on attitude. Female HCWs had poorer attitude to work than males.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Pneumonia Viral/psicologia , Adulto , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Medo , Feminino , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Nigéria , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
2.
Prim Health Care Res Dev ; 21: e47, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33109285

RESUMO

AIM: Family physicians are role models for their societies in disaster management and have an important place in it. This study was carried out during the specialty training of the residents, who are currently family physicians fighting against COVID-19 in the field, and was aimed to identify the awareness levels of residents regarding the roles and duties of family physicians before, during, and after disasters and to increase their awareness of disaster medicine and management. BACKGROUND: The duties and responsibilities of a family physician in disasters should be a part of their specialty training. This study has contributed to the limited literature, increased awareness, and opened a new avenue of research for studies to be conducted with family physicians by demonstrating the current situation of family physicians in disaster management. METHODS: This is an observational and descriptive study. The knowledge, experience, opinions, willingness, attitudes of the residents, and the awareness levels of the residents regarding their roles and duties in a disaster were evaluated along with their sociodemographic information. The surveys were applied in the family medicine clinics of the all residents by the interview method (n = 233). FINDINGS: Only 9.2% of the residents stated that they had received training on disaster medicine where they currently work. The knowledge level of the residents on this subject was found as 'Unsure'. In total, 80% of the residents stated that family physicians should have a role in disasters. It was found that 83.3% of the residents had never joined a disaster drill, 94.3% had never participated in making or applying a disaster plan, and 97.7% had never worked in any disaster. CONCLUSION: The residents participating in the study lacked not only information on disaster management but also experience. The residents' willingness to receive training, work voluntarily, significantly question the curriculum, and specialize in disaster medicine were a positive outcome.


Assuntos
Competência Clínica/estatística & dados numéricos , Medicina de Desastres/métodos , Internato e Residência/estatística & dados numéricos , Papel do Médico , Médicos de Família/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Turquia , Adulto Jovem
3.
Can J Surg ; 63(5): E396-E408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009899

RESUMO

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Padrões de Prática Médica/estatística & dados numéricos , Âmbito da Prática/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Canadá , Competência Clínica/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Feminino , Cirurgia Geral/economia , Cirurgia Geral/educação , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Cirurgiões/economia , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação
4.
West J Emerg Med ; 21(5): 1080-1083, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970558

RESUMO

INTRODUCTION: Barrier enclosures have been developed to reduce the risk of COVID-19 transmission to healthcare providers during intubation, but little is known about their impact on procedure performance. We sought to determine whether a barrier enclosure delays time to successful intubation by experienced airway operators. METHODS: We conducted a crossover simulation study at a tertiary academic hospital. Participants watched a four-minute video, practiced one simulated intubation with a barrier enclosure, and then completed one intubation with and one without the barrier enclosure (randomized to determine order). The primary outcome measure was time from placement of the video laryngoscope at the lips to first delivered ventilation. Secondary outcomes were periprocedural complications and participant responses to a post-study survey. RESULTS: Proceduralists (n = 50) from emergency medicine and anesthesiology had median intubation times of 23.6 seconds with practice barrier enclosure, 20.5 seconds with barrier enclosure, and 16.7 seconds with no barrier. Intubation with barrier enclosure averaged 4.5 seconds longer (95% confidence interval, 2.7-6.4, p < .001) than without, but was less than the predetermined clinical significance threshold of 10 seconds. Three complications occurred, all during the practice intubation. Barrier enclosure made intubation more challenging according to 48%, but 90% indicated they would consider using it in clinical practice. CONCLUSION: Experienced airway operators performed intubation using a barrier enclosure with minimal increased time to procedure completion in this uncomplicated airway model. Given potential to reduce droplet spread, use of a barrier enclosure may be an acceptable adjunct to endotracheal intubation for those familiar with its use.


Assuntos
Betacoronavirus , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/instrumentação , Pneumonia Viral/terapia , Adulto , Anestesiologia , Infecções por Coronavirus/transmissão , Estudos Cross-Over , Medicina de Emergência , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscópios , Masculino , Manequins , Pandemias , Pneumonia Viral/transmissão , Fatores de Tempo
5.
West J Emerg Med ; 21(5): 1089-1094, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32970559

RESUMO

INTRODUCTION: The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient. METHODS: This was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31-April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials. Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences. RESULTS: All participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9-75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7-29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%. CONCLUSION: A mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Treinamento por Simulação/métodos , California , Lista de Checagem , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência , Humanos , Controle de Infecções/instrumentação , Pneumonia Viral/transmissão
7.
Hu Li Za Zhi ; 67(4): 61-71, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32748380

RESUMO

BACKGROUND: After graduation, new nurses provide care directly to clients in the health and social care sectors. Nurses with higher levels of health and social care competences have been shown to provide better quality of care. The skills competitions organized and held by the Ministry of Labor follow international standards and address the general roles and functions of care providers worldwide. Using the results of these skills competitions to confirm the health and social care competences of nursing students important for nursing education. PURPOSE: This study was designed to assess the performance of nursing students in the skills competition and to identify the strengths and weaknesses of these students with regard to related competences in the context of current global standards. METHODS: This was a retrospective research study. Data were collected from the results of skills competitions using the Scenario-based Objective Structured Clinical Examination method. Descriptive statistics were used to analysis the data. RESULTS: The mean score for health and social care competence was 67.9 ± 12.9. The score for the home care dimension (65.1 ± 14.1) was the lowest dimension score. The most two improved of the six competence dimensions were problem solving/innovation and creativity (53.7 ± 3.9) and evaluating response to care (55.9 ± 4.0). The lowest health and social care item scores were practicing the five moments of hand hygiene (42.7%) and encouraging patient to discuss health problems (43.1%). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results showed that the competence level of the students was moderate. Nursing educators should develop appropriate education approaches for teaching and evaluation and improve the health and social care competences of nursing students.


Assuntos
Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Estudantes de Enfermagem , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Estudos Retrospectivos
8.
Hu Li Za Zhi ; 67(4): 72-80, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32748381

RESUMO

BACKGROUND & PROBLEMS: The most effective treatment currently available for perinatal asphyxia-induced hypoxic-ischemic encephalopathy is therapeutic hypothermia, which reduces the mortality rate and neurological disorders in newborns. The earlier this therapy is performed, the better the protective effects on the nerves of the patient. In our neonatal intensive care unit (NICU), we discovered that nurses lack experience caring for patients undergoing hypothermia therapy due to the limited number of cases. In addition, outdated guidelines, the disorganized placement of equipment, and the paucity of hands-on simulations exacerbate the unfamiliarity of the nurses with this therapy. PURPOSE: To expand the knowledge of nurses regarding therapeutic hypothermia in the NICU and to increase the rate of completion of the therapeutic hypothermia procedure. RESOLUTIONS: 1. Regular care training programs and scenario-based simulations were conducted to help nurses obtain related knowledge and become more familiar with therapeutic hypothermia. 2. In order to reduce the preparation time, a specific preparation kit and an instruction folder for therapeutic hypothermia was developed that included a material placement checklist. 3. The procedure guidance booklet for therapeutic hypothermia was revised and a monitoring system was established. RESULTS: The accuracy of nurses' knowledge regarding therapeutic hypothermia in the NICU improved from 82.0% to 94.5%. The completion rate for the therapeutic hypothermia procedure rose from 75.6% to 100.0%. CONCLUSIONS: This project successfully enhanced the accuracy of nurses' knowledge regarding therapeutic hypothermia and increased the rate of completion for this care procedure, resulting in a safer and more-standardized procedure for neonates undergoing therapeutic hypothermia.


Assuntos
Hipotermia Induzida/enfermagem , Hipotermia Induzida/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Recursos Humanos de Enfermagem no Hospital/educação , Competência Clínica/estatística & dados numéricos , Humanos , Recém-Nascido , Pesquisa em Avaliação de Enfermagem
10.
PLoS One ; 15(8): e0237670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790797

RESUMO

BACKGROUND: Efforts to characterize healthcare professional students' lesbian, gay, bisexual, and transgender (LGBT) cultural competency are necessary to recommend educational initiatives. Very few studies have evaluated LGBT cultural competency across multiple healthcare disciplines, and no known studies have included students of other healthcare disciplines such as occupational therapy, pharmacy, physical therapy, and physician assistant. METHODS: Healthcare professional students (N = 1701) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., LGBT patients and LGBT curricular hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores, annual LGBT patients, and annual LGBT curricular hours were compared across healthcare disciplines. RESULTS: While students reported very high Attitudinal Awareness (M = 6.48, SD = 0.92), they endorsed moderate Basic Knowledge (M = 5.54, SD = 1.16) and low Clinical Preparedness (M = 3.78, SD = 1.28). After controlling for several demographic and experiential variables, there were significant differences among healthcare disciplines on LGBT-DOCSS scores, with social work students reporting the highest on all scores, and dental students reporting the lowest on all scores except Clinical Preparedness. There were also significant differences among healthcare disciplines on annual LGBT patients [mean range: 0.57 (dental) to 7.59 (physician assistant)] and annual LGBT curricular hours [mean range: 0.51 (occupational therapy) to 5.64 (social work)]. Experiential variables were significant predictors for Overall LGBT-DOCSS, Clinical Preparedness, and Basic Knowledge (all p < 0.001); LGBT patients was also a significant predictor for Attitudinal Awareness (p < 0.05). CONCLUSIONS: Taken together, significant differences in LGBT cultural competency exist across healthcare disciplines, which may result from inadequate experiences with LGBT patients and LGBT curricular education. Future efforts should consider increasing LGBT patient contact hours and LGBT formal education hours to enhance healthcare students' LGBT cultural competency.


Assuntos
Competência Clínica/estatística & dados numéricos , Competência Cultural , Ocupações em Saúde/educação , Minorias Sexuais e de Gênero/psicologia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adulto , Currículo , Feminino , Humanos , Masculino , Estados Unidos , Adulto Jovem
11.
Eur J Obstet Gynecol Reprod Biol ; 253: 48-51, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32771888

RESUMO

OBJECTIVE: to evaluate the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. STUDY DESIGN: This was a cross-sectional survey study aimed to assess the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. An online survey with 45 questions was sent and completed anonymously by residents after accepting an informed consent. The invitation to the online survey was sent to all the Italian residents in obstetrics and gynecology. Those on maternity leave at the time of the study were excluded. Residents were asked about their routinely activity before the COVID-19 pandemic, and to report the reduction in their clinical practice. They were also asked about psychological impact of COVID-19 on their clinical practice. RESULTS: 933 Italian residents in obstetrics and gynecology, were invited for this survey study. Four-hundred and seventy-six (51 %) completed the survey and were included in the study. Three-hundred and eighty-seven (81.3 %) were female, and 89 (18.7 %) were male. Residents age ranged from 25 to 42. In 71,8 % (342/476) of the cases residents work in a COVID-19 reference Hospitals. One-hundred and eighty-four out of 76 residents (38.6 %) were tested on RT-PCR assay of nasal and pharyngeal swab specimens, and of them 12/184 (6.5 %) were positive to SARS-COV-2. Regarding the use of personal protective equipment (PPE), 267 (56.1 %) reported to receive adequate device, and 379 (79.6 %) felt to be well informed about prevention and management protocols. Three-hundred and thirty-one residents (69.5 %) reported to have managed COVID-19 positive patients. For 54,7 % of respondent residents, training activity in general decreased significantly during the COVID-19 epidemic. A one-third reduction was reported in 31,4 % of the cases, whereas a total suspension of the training in 9,9 % of the cases. In 89,3 % of cases the reduction was caused by the reorganization of work. Anxiety about the professional future was reported in 84 % of the residents, and 59 % of them had the perception that their training was irreversibly compromised. CONCLUSIONS: Among Italian residents in obstetrics and gynecology, COVID-19 pandemic was associated with a significant training impairment.


Assuntos
Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus , Ginecologia/educação , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Feminino , Humanos , Itália/epidemiologia , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia
13.
Curationis ; 43(1): e1-e8, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32633991

RESUMO

BACKGROUND: Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources. OBJECTIVES: The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. METHOD: A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0. RESULTS: The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency. There was no correlation between the self-reported competency and knowledge (r = 0.08, p = 0.4402), and self-reported competency and OSCE scores (r = -0.004, p = 0.01). CONCLUSION: The high mean scores for the knowledge and the OSCE indicate that the theoretical component of the curriculum on the active management of the third stage of labour was effective in equipping final-year midwifery students with knowledge and skills to carry out this competency.


Assuntos
Competência Clínica/normas , Terceira Fase do Trabalho de Parto/fisiologia , Tocologia/educação , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Competência Clínica/estatística & dados numéricos , Currículo/tendências , Feminino , Humanos , Tocologia/estatística & dados numéricos , Gravidez , África do Sul , Inquéritos e Questionários
14.
Trop Doct ; 50(4): 299-303, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32611225

RESUMO

Traditional Halstead teaching, which is time- and opportunity-dependent, has often been replaced by 'boot' camps which involve expensive modules and are usually a grand one-time event. This does not suit the complex teaching and learning needs of low- and middle-income countries (LMICs). We studied the impact of a needs-driven surgical training course implemented instead. The course was taken by 17 first-year residents of surgery, and included a pre-course knowledge assessment test, pre-test skills assessment, as well as post-test assessment and feedback impressions.Mean post-test scores improved significantly (P < 0.05) in all eight skills areas, though only 7 (44.11%) scored ≥80% in tests after the course, but all 17 in theoretical and clinical skills. There was strong agreement over all six points that the needs-driven course was of benefit. Our short and intensive needs-driven skills video training course for surgical residents fills the gap in skills development for general surgery residents.


Assuntos
Competência Clínica , Cirurgia Geral/educação , Internato e Residência/métodos , Competência Clínica/estatística & dados numéricos , Países em Desenvolvimento , Avaliação Educacional , Humanos , Internato e Residência/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde
15.
Medicine (Baltimore) ; 99(24): e20559, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541480

RESUMO

It is important to improve the training for nursing home staff in order to achieve better quality of life for the elderly.This study aimed to develop a systematic training program for nursing home staff based on the concept of combination of medicine and care.Thirty-four nursing staff from 2 representative nursing homes in Qiqihar City were selected as study subjects and divided into experimental and control groups. The subjects in both groups received routine training following "National Occupational Standards of Elderly Nursing Staff". In addition, the subjects in experimental groups received systematic training at three levels based on the concept of combination of medicine and care for 4 months.After the training, the competence scores of nursing staff in experimental group increased significantly compared to control group, the living quality of the elderly in nursing homes cared by nursing staff in experimental group was significantly improved, and the satisfaction of the elderly to nursing staff in experimental group improved significantly, compared to control group (P < .05).We develop systematic training program for nursing home staff based on the concept of combination of medicine and care, which can improve nursing care for the elderly in nursing home.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Recursos Humanos de Enfermagem/educação , Adulto , Idoso , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/estatística & dados numéricos
16.
Br J Anaesth ; 125(2): 168-174, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32560911

RESUMO

BACKGROUND: The effect of mental rotation training on ultrasound-guided regional anaesthesia (UGRA) skill acquisition is currently unknown. In this study we aimed to examine whether mental rotation skill training can improve UGRA task performance by novice operators. METHODS: We enrolled 94 volunteers with no prior experience of UGRA in this randomised controlled study. After a baseline mental rotation test, their performance in a standardised UGRA needling task was independently assessed by two raters using the composite error score (CES) and global rating scale (GRS). Volunteers with low baseline mental rotation ability were randomised to a mental rotation training group or a no training group, and the UGRA needling task was repeated to determine the impact of the training intervention on task performance. The study primary outcome measure was UGRA needling task CES measured before and after the training intervention. RESULTS: Multivariate analyses controlling for age, gender, and previous performance showed that participants exposed to the training intervention made significantly fewer errors (CES B=-0.66 [standard error, se=0.17]; P<0.001; 95% confidence interval [CI], -0.92 to -0.26) and displayed improved overall performance (GRS B=6.15 [se=2.99], P=0.048, 95% CI=0.06 to 12.13) when undertaking the UGRA needling task. CONCLUSIONS: A simple training intervention, based on the manipulation and rotation of three-dimensional models, results in improved technical performance of a UGRA needling task in operators with low baseline mental rotation skills.


Assuntos
Anestesia por Condução/métodos , Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Percepção Espacial/fisiologia , Ultrassonografia de Intervenção/métodos , Percepção Visual/fisiologia , Adulto , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto Jovem
17.
Acad Med ; 95(7): 1050-1056, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576763

RESUMO

PURPOSE: It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). METHOD: All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. RESULTS: Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students' overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. CONCLUSIONS: It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.


Assuntos
Variação Contingente Negativa/fisiologia , Avaliação Educacional/métodos , Internato e Residência/métodos , Aprendizagem/fisiologia , Treinamento por Simulação/métodos , Adulto , Lista de Checagem , Chicago/epidemiologia , Competência Clínica/estatística & dados numéricos , Comunicação , Currículo , Avaliação Educacional/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Medicina/métodos , Estudantes de Medicina , Universidades/estatística & dados numéricos
18.
Acad Med ; 95(7): 1057-1065, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576764

RESUMO

PURPOSE: Feedback is important for medical students' development. Recent conceptualizations of feedback as a dialogue between feedback provider and recipient point to longitudinal relationships as a facilitator of effective feedback discussions. This study illuminates how medical students experience feedback within a longitudinal relationship with a physician coach. METHOD: In this qualitative study, second-year medical students from the University of California, San Francisco, School of Medicine participated in semistructured interviews that explored their experiences discussing feedback within longitudinal, nonevaluative coaching relationships. Interviews occurred between May and October 2018. Interview questions addressed students' experiences receiving feedback from their coach, how and when they used this feedback, and how their relationship with their coach influenced engagement in feedback discussions. Interviews were analyzed using constructivist grounded theory. RESULTS: Seventeen students participated. The authors identified 3 major themes. First, students' development of a feedback mindset: Over time, students came to view feedback as an invaluable component of their training. Second, setting the stage for feedback: Establishing feedback routines and a low-stakes environment for developing clinical skills were important facilitators of effective feedback discussions. Third, interpreting and acting upon feedback: Students described identifying, receiving, and implementing tailored and individualized feedback in an iterative fashion. As students gained comfort and trust in their coaches' feedback, they reported increasingly engaging in feedback conversations for learning. CONCLUSIONS: Through recurring feedback opportunities and iterative feedback discussions with coaches, students came to view feedback as essential for growth and learning. Longitudinal coaching relationships can positively influence how students conceptualize and engage in feedback discussions.


Assuntos
Retroalimentação , Aprendizagem/fisiologia , Tutoria/métodos , Aprendizagem Baseada em Problemas/estatística & dados numéricos , Estudantes de Medicina/psicologia , Adulto , Competência Clínica/estatística & dados numéricos , Comunicação , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Entrevistas como Assunto , Masculino , Tutoria/estatística & dados numéricos , Pesquisa Qualitativa , São Francisco/epidemiologia , Universidades/estatística & dados numéricos
19.
Tunis Med ; 98(5): 363-369, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32548839

RESUMO

INTRODUCTION: Simulation is a growing pedagogical method in training health professionals. The use of high-fidelity simulators may be associated with significant stress. OBJECTIVE: to measure self-assessed intensity of stress before and after a planned simulation training session of a third degree atrio-ventricular block  among  medical students. METHODS: A sample of 30 students participating in a high-fidelity simulation training course (10 playing the role of team leader and 20 in the role of medical intern) was studied. Stress was evaluated by self-assessment using a numerical scale before and after the session. The peri-traumatic distress inventory was used to measure the level of distress experienced by the participants. RESULTS: The median stress score was 3, 5±2, 4 before and 6, 2±2, 4 after the simulation session (p<0.001). Stress intensity increased significantly after the session in students playing the role of the team leader than those playing the role of medical intern (8, 4±0, 8 versus 5, 2±2, 3 p<0.001).The average score for peri-traumatic distress inventory was also significantly higher in the team leaders (18, 8±10, 4 Vs 9, 2±3, 7 p=0,022). CONCLUSION: Simulation-induced stress, as measured by self-assessment, increased significantly after the session and was influenced by the role to be played during the scenario.  Stress should be taken into account before debriefing.


Assuntos
Treinamento com Simulação de Alta Fidelidade , Internato e Residência , Estresse Psicológico/diagnóstico , Estudantes de Medicina , Adulto , Competência Clínica/estatística & dados numéricos , Feminino , Treinamento com Simulação de Alta Fidelidade/estatística & dados numéricos , Humanos , Internato e Residência/métodos , Internato e Residência/estatística & dados numéricos , Masculino , Autoavaliação , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
20.
Eur Spine J ; 29(8): 1806-1812, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32591880

RESUMO

PURPOSE: The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden. METHODS: This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice. RESULTS: Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (ß = 0.33, 95% CI 0.11-0.56), orthopedic spine surgeons (ß = 0.30, 95% CI 0.01-0.61) and those who work in the private sector (ß = 0.05, 95% CI 0.19-0.61) were the most affected by COVID-19. Those who work in university hospitals (ß = - 0.36, 95% CI 0.00 to - 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively. CONCLUSION: While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6-12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus , Cirurgiões Ortopédicos , Pandemias , Pneumonia Viral , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/economia , Estresse Ocupacional/etiologia , Estresse Ocupacional/psicologia , Cirurgiões Ortopédicos/economia , Cirurgiões Ortopédicos/psicologia , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Inquéritos e Questionários
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