A Simulated Night on Call Experience for Graduating Medical Students.
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ABSTRACT: Introduction
A number of medical schools have developed capstone courses to help prepare medical students for their transition to residency training. As part of our capstone program, we developed a Night on Call experience for graduating medical students to simulate the experience of an intern physician responding to medical emergencies in the hospital setting.Methods
Our 2-hour program incorporates high-fidelity simulation in a four-station format (four clinical cases) with semistructured debriefing at the conclusion of the experience.Results
The program has been well received. The majority of students report that the exercise achieves its learning objectives and has been a valuable experience. In addition, the students note that our cases offer a realistic experience.Discussion
A program such as this allows the faculty an opportunity to observe and provide formative feedback to the students regarding their clinical performance when caring for patients in a simulated inpatient setting.
SUBMITTER: Wald D
PROVIDER: S-EPMC6440402 | biostudies-literature | 2016 Oct
REPOSITORIES: biostudies-literature
Publications
A Simulated Night on Call Experience for Graduating Medical Students.
Wald David D Peet Alisa A Cripe Jane J Kinloch Michaella M
MedEdPORTAL : the journal of teaching and learning resources 20161013
<h4>Introduction</h4>A number of medical schools have developed capstone courses to help prepare medical students for their transition to residency training. As part of our capstone program, we developed a Night on Call experience for graduating medical students to simulate the experience of an intern physician responding to medical emergencies in the hospital setting.<h4>Methods</h4>Our 2-hour program incorporates high-fidelity simulation in a four-station format (four clinical cases) with semi ...[more]
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Project description:ImportanceDermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US.ObjectivesTo examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation.Design, setting, and participantsThis secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires.Main outcomes and measuresThe proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology.ResultsA total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98).Conclusions and relevanceThe findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.
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Project description:BackgroundThe dearth of health workers in rural settings in Lao People's Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package.MethodsWe use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density.ResultsRelative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package's incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement, are not efficient.ConclusionConditional on using voluntary incentives, Lao PDR should emphasize non-capital intensive options such as advanced career promotion, transport subsidies and housing allowances to improve physician distribution and rural health outcomes in a cost-effective manner. Other countries considering voluntary incentive programs can implement health worker/trainee DCEs and costing surveys to determine which incentive bundles improve rural uptake most efficiently but should be aware of methodological caveats.
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Project description:BackgroundUndergraduate medical education (UME) follows the lead of graduate medical education (GME) in moving to competency-based assessment. The means for and the timing of competency-based assessments in UME are unclear.ObjectiveWe explored the feasibility of using the Accreditation Council for Graduate Medical Education Transitional Year (TY) Milestones to assess student performance during a mandatory, fourth-year capstone course.MethodsOur single institution, observational study involved 99 medical students who completed the course in the spring of 2014. Students' skills were assessed by self, peer, and faculty assessment for 6 existing course activities using the TY Milestones. Evaluation completion rates and mean scores were calculated.ResultsStudents' mean milestone levels ranged between 2.2 and 3.6 (on a 5-level scoring rubric). Level 3 is the performance expected at the completion of a TY. Students performed highest in breaking bad news and developing a quality improvement project, and lowest in developing a learning plan, working in interdisciplinary teams, and stabilizing acutely ill patients. Evaluation completion rates were low for some evaluations, and precluded use of the data for assessing student performance in the capstone course. Students were less likely to complete separate online evaluations. Faculty were less likely to complete evaluations when activities did not include dedicated time for evaluations.ConclusionsAssessment of student competence on 9 TY Milestones during a capstone course was useful, but achieving acceptable evaluation completion rates was challenging. Modifications are necessary if milestone scores from a capstone are intended to be used as a handoff between UME and GME.
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Project description:IntroductionSterile technique is a basic technical skill used for a number of bedside procedures. Proper use of sterile technique improves patient safety by reducing infection risk.MethodsWe applied the principles of mastery learning to develop a simulation-based mastery learning module for sterile technique that was used as part of a 2-week internship preparatory course for fourth-year medical students. Forty-one medical students entering surgical or emergency medicine internships completed the module. Learners demonstrated baseline skills with a pretest, watched a didactic online video, participated in supervised deliberate practice sessions, and then completed a posttest. Physicians evaluated performance using a nine-item mastery checklist validated by a multispecialty panel of board-certified physicians. Learners who did not demonstrate mastery by correctly performing all nine checklist items received formative feedback and repeated the posttest as needed until mastery was achieved.ResultsNo learners demonstrated mastery of sterile technique during pretesting. A total of 100% of learners demonstrated mastery of sterile technique during either their first or second attempt of the posttest. The learners reported statistically significantly higher levels of confidence at the end of the module.DiscussionOur module highlights the skills gap that exists in the transition from undergraduate to graduate medical education and offers a cheap, effective, and easily reproducible curriculum for sterile technique that could be widely adopted for many learner populations.
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Project description: Not available
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| S-EPMC8076371 | biostudies-literature
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Project description:IntroductionInterns must be able to give and receive handoffs and use handoff information to respond to calls from nursing staff regarding patient concerns. Medical students may not receive adequate instruction in these tasks and often feel unprepared in this aspect of transitioning to residency. This program simulated an overnight call experience for fourth-year medical students emphasizing handoffs, nurse calls, and medical emergency response.MethodsThe program utilized a combination of traditional didactics and simulated handoffs, nurse calls, and patient scenarios to allow groups of fourth-year medical students to independently manage a simulated overnight call. The program was designed for students as part of a larger Transition to Residency capstone course.ResultsWe ran four sessions over 3 years, with a total of 105 medical student participants. All students reported increased confidence or comfort in their ability to manage handoffs and respond to nurse calls. Students reported that the sessions were helpful and realistic.DiscussionThis program provided fourth-year medical students with a realistic and useful opportunity to simulate handoffs and response to nurse calls, which increased their confidence and comfort. Minor changes were made between iterations of the course with continued positive feedback from medical students. The course is generalizable and can be adapted to the needs and resources of different institutions.
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