Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media.

OBJECTIVES: Acute otitis media (AOM) is the most common reason for pediatric antibiotic prescriptions. The 2013 American Academy of Pediatrics' AOM guidelines recommend observation for nonsevere AOM. Our aim was to increase the percentage safety-net antibiotic prescription (SNAP) offered to patients 6 months of age or older diagnosed with AOM in 2 pediatric emergency departments (EDs) from a baseline of 0.5% to 15% in 20 months. METHODS: This is a quality improvement study at a quaternary pediatric medical center with 2 locations, both with EDs. A random chart review revealed that 27.5% of patients diagnosed with AOM in the ED would qualify for a SNAP, but only 0.5% were offered it. Quality improvement interventions were designed to improve safety-net antibiotic prescribing. Both EDs conducted multiple interventions, including algorithm development, provider education, and electronic medical record aids. The primary outcome measure was the percentage of patients offered a SNAP for AOM. RESULTS: A total of 8226 children 6 months of age or older were diagnosed with AOM in our 2 EDs during the 20-month intervention period. The percentage offered a SNAP increased at both EDs. One ED had a single shift in the mean to 7.9%, whereas the other had 2 shifts in the mean, an initial shift to 5.1% and a second to 7.3%. Providers consistently used the algorithm and electronic medical record aids. CONCLUSIONS: Safety-net antibiotic prescriptions in conjunction with parent education was effective in reducing the use of immediate antibiotic prescriptions in children with AOM in 2 pediatric EDs. Offering a SNAP can reduce unnecessary use of antibiotics, which in turn may decrease antibiotic-related adverse events and antibiotic resistance.

Why not just Google it? An assessment of information literacy skills in a biomedical science curriculum.

BACKGROUND: Few issues in higher education are as fundamental as the ability to search for, evaluate, and synthesize information. The need to develop information literacy, the process of finding, retrieving, organizing, and evaluating the ever-expanding collection of online information, has precipitated the need for training in skill-based competencies in higher education, as well as medical and dental education. METHODS: The current study evaluated the information literacy skills of first-year dental students, consisting of two, consecutive dental student cohorts (n = 160). An assignment designed to evaluate information literacy skills was conducted. In addition, a survey of student online search engine or database preferences was conducted to identify any significant associations. Subsequently, an intervention was developed, based upon the results of the assessment and survey, to address any deficiencies in information literacy. RESULTS: Nearly half of students (n = 70/160 or 43%) missed one or more question components that required finding an evidence-based citation. Analysis of the survey revealed a significantly higher percentage of students who provided incorrect responses (n = 53/70 or 75.7%) reported using Google as their preferred online search method (p < 0.01). In contrast, a significantly higher percentage of students who reported using PubMed (n = 39/45 or 86.7%) were able to provide correct responses (p < 0.01). Following a one-hour intervention by a health science librarian, virtually all students were able to find and retrieve evidence-based materials for subsequent coursework. CONCLUSIONS: This study confirmed that information literacy among this student population was lacking and that integration of modules within the curriculum can help students to filter and establish the quality of online information, a critical component in the training of new health care professionals. Furthermore, incorporation of these modules early in the curriculum may be of significant value to other dental, medical, health care, and professional schools with similar goals of incorporating the evidence base into teaching and learning activities.

Research enrichment: evaluation of structured research in the curriculum for dental medicine students as part of the vertical and horizontal integration of biomedical training and discovery.

BACKGROUND: Research programs within medical and dental schools are important vehicles for biomedical and clinical discovery, serving as effective teaching and learning tools by providing situations in which predoctoral students develop problem-solving and critical-thinking skills. Although research programs at many medical and dental schools are well-established, they may not be well integrated into the predoctoral curriculum to effectively support the learning objectives for their students. METHODS: A series of structured seminars, incorporating faculty research, was designed for first-year dental students at the University of Nevada, Las Vegas, School of Dental Medicine to reinforce and support the concepts and skills taught in concurrent courses. A structured research enrichment period was also created to facilitate student engagement in active research using faculty and student curricular release time. Course evaluations and surveys were administered to gauge student perceptions of the curricular integration of research, the impact of these seminars on recruitment to the research program, and overall levels of student satisfaction with research enrichment. RESULTS: The analysis of course surveys revealed that students perceived the research-containing seminars effectively illustrated concepts, were logically sequenced, and were well-integrated into their curriculum. In addition, analysis of surveys revealed that the Integration Seminar courses motivated students to engage in research enrichment. Finally, this analysis provided evidence that students were very satisfied with their overall learning experience during research enrichment. CONCLUSION: Curricular integration is one method of improving the teaching and learning of complicated and inter-related concepts, providing an opportunity to incorporate research training and objectives into traditionally separate didactic courses. Despite the benefits of curricular integration, finding the most appropriate points of integration, obtaining release time for curricular development and for research engagement, and funding predoctoral student research remain issues to be addressed in ways that reflect the character of the faculty and the goals of each institution.

The integration seminar: a first-year dental course integrating concepts from the biomedical, professional, and clinical sciences.

This study describes the planning, implementation, and evaluation of a seminar course designed to facilitate discussion and understanding of cross-disciplinary concepts by first-year dental students. Dental and medical schools are implementing integrated curricula in which clinical courses are taught early in the curriculum and the clinical and basic sciences are taught not only concurrently, but in an integrated manner. This first-year course, Integration Seminar, was developed to cross traditional subject and departmental boundaries with the intent of fostering dental care providers who understand the interdependence of the major concepts within these areas. This report describes the development and structure of the Integration Seminar. Furthermore, student perception of this course was determined by evaluating year-end course surveys, and student performance outcomes were measured by comparing student scores on the National Board Dental Examination Part I (NBDE-I) prior to and after the inception of this course. We determined that a substantial majority of students recognized the integrated nature of the course. In addition, NBDE-I scores were significantly higher for the cohorts of students who had participated in the course, although this observation is likely dependent upon many other factors. This report may thus provide a course model for other schools with a similar goal of achieving an integrated curriculum.

An integrated curriculum: evolution, evaluation, and future direction.

The topic of curriculum reform has received an enormous amount of attention in the field of dental education. While recently established dental schools benefit from the evolution of curriculum change and innovation in constructing their new curricula, these advantages can become lost if the curriculum is not assessed to ascertain the degree to which the curriculum accurately reflects the initial intended goals. The purpose of this educational research project was to evaluate a dental school curriculum to determine the extent of vertical and horizontal integration originally intended. After a faculty retreat that presented a historical perspective and prevalent concepts of the definitions of an integrated curriculum, a survey instrument was distributed to all course directors asking them to assign each of their courses to one of ten established models of integration. Analysis of the survey results allowed the mapping of each of the eighty-four courses to four themes of integration. Chi-square analysis demonstrated courses were distributed in a classic bell-shaped curve along the integration continuum. Dental school year 4 courses mapped to the highest levels of integration, while no courses were assigned to the lowest level (fragment or silo model). All courses were found to have at least some level of integration. More than half (n=43) were found to be both horizontally and vertically integrated.