National survey of invasive procedural training for nephrology fellows and residents in France: from bedside mentoring to simulation-based teaching
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ABSTRACT:
SUBMITTER: Bobot M
PROVIDER: S-EPMC7857789 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND: Residents perform invasive bedside procedures in most training programs. To date, there is no universal approach for determining competency and ensuring quality and safety of care. OBJECTIVE: We developed and implemented an assessment of central venous catheter insertion competency for internal medicine and internal medicine-pediatrics residents, using measurements for knowledge, skill, and attitude and linking them to procedural outcomes. METHODS: We conducted a cohort study of a 4-week, resident-run procedure service from July 2007 through June 2011 at a large academic medical center. Knowledge was assessed by using a written test, technical skill by using a checklist, and attitude by self- and supervisor assessments of residents' confidence and capability. Competence was defined as (1) a minimum written test score (70%); (2) a perfect checklist score; (3) a resident's self-assessed confidence and capability scores of 4 or 5 of 5; and (4) faculty rating of the resident's confidence and capability as 5 of 5. A composite success rate was based on procedural outcomes (eg, completed procedures, less than 3 forward needle passes, and complication rate) and was compared to the checklist scores. RESULTS: A total of 148 internal medicine and medicine-pediatrics residents inserted 639 catheters, and 53 (36%) achieved competence by the end of 4 weeks. Residents judged to be competent by checklist scores had a higher composite success rate than those deemed not competent. CONCLUSIONS: Our multi-factorial criteria used to define central venous catheter insertion competency effectively discriminated between residents judged to be competent and those judged not competent, using data from procedural outcomes.
| S-EPMC3886459 | biostudies-other
Project description:BackgroundPhysician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work.ObjectiveTo provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts.Methods"Back to Bedside" resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions.ResultsBack to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals.ConclusionsA national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.
| S-EPMC5398141 | biostudies-literature
Project description:IntroductionThe purpose of the case is to teach health care professionals to recognize Henoch-Schönlein purpura (HSP), including rare and serious complications. The case includes a review of epidemiology, classification, clinical manifestations, and treatment of HSP.MethodsUtilizing an adolescent simulation mannequin, we present the case of an 11-year-old female who presents to a pediatric emergency department with HSP and respiratory symptoms requiring intubation. This case reinforces the appearance of the characteristic rash and helps learners develop an algorithm for HSP management that includes the identification and management of abdominal pain associated with HSP, as well as the rare and serious complication of pulmonary vasculitis. We focus learners on managing severe respiratory distress in the HSP patient. Learners are assessed using standardized forms, and the learner outcome measurements include the recognition of HSP and successful management of abdominal pain and respiratory failure in this unique setting.ResultsThis module has been used with pediatric residents, emergency medicine residents, pediatric emergency medicine fellows, and pediatric emergency medicine nurse practitioners. Approximately 30 learners have completed this module during seven separate sessions. All learners felt the case provided the opportunity to identify HSP as well as to manage a serious and rare complication of the disease.DiscussionOverall, we have had positive feedback from the learners about this case, and it provides them the opportunity to see more rare complications during their training period. Learners leave the session with enhanced knowledge of HSP, as well as a review of respiratory failure and intubation.
| S-EPMC6342163 | biostudies-literature
Project description:Conservative care, a comprehensive treatment path for advanced kidney disease most suitable for individuals unlikely to benefit from dialysis, is underutilized in the United States. One reason is an absence of robust education about this approach and how to discuss it with potential candidates. To address this need, we developed a multimodal conservative care curriculum for nephrology fellows. This curriculum consists of four online modules that address essential concepts and communication skills related to conservative care. It is followed by an in-person, interactive, "flipped classroom" session facilitated by designated nephrology educators at participating Accreditation Council for Graduate Medical Education nephrology training programs. Curriculum effect was assessed using surveys completed by participating fellows immediately before and following the curriculum and for participating nephrology educators following flipped classroom teaching; 148 nephrology trainees from 19 programs participated, with 108 completing both pre- and postcurriculum surveys. Mean self-reported preparedness (measured on a five-point Likert scale) increased significantly for all ten concepts taught in the curriculum. The mean correct score on eight knowledge questions increased from 69% to 82% following the curriculum (P<0.001). Fellows rated the curriculum highly and reported that they plan to practice skills learned. For the 19 nephrology program educators, the mean perceived preparedness to teach all curriculum domains increased after, compared with before, facilitating the flipped classroom, reaching significance for seven of the ten concepts measured. Data suggest that fellows' participation in a multimodal curriculum increased knowledge and preparation for fundamental conservative care concepts and communication skills. Fellows rated the curriculum highly. Educator participation appears to have increased preparedness for teaching the curriculum concepts, making it likely that future education in conservative care will become more widespread. Herein, we describe the curriculum content, which we have made publicly available in order to encourage broader implementation, and its effect on participating fellows and the nephrology educators who facilitated it.
| S-EPMC8216616 | biostudies-literature
Project description:IntroductionHealth care quality and patient safety remain one of the core areas of focus for the Accreditation Council for Graduate Medical Education. In addition to using the traditional approach to teaching patient safety, disclosure of a safety event and introduction to the concepts of just culture and safely doing less add a unique perspective to our module.MethodsThis 4-hour learning activity was conducted using a formal PowerPoint presentation, simulation, and interactive discussion/debriefing. The presentation reviewed safety concepts and introduced learners to the concepts of just culture and safely doing less. The first case was a standard scenario in which participants assessed a sick but stable child and evaluated the use of premature closure bias that might preclude them from making the correct diagnosis. The second case represented disclosure of a medical error. Participants were evaluated on their communication/professionalism skills and challenged to discover overuse as one of the root causes of medication error. Pre- and posttest surveys were used for learner evaluation.ResultsParticipants showed significant improvement on content-based questions, increasing from 51.7% to 69.3% correct (p < .001). After Bonferroni correction, only the question on overdiagnosis showed significant improvement (p = .001). Participants reported significantly increased confidence in all areas evaluated (p < .001).DiscussionParticipants placed high value on the workshop. The question on overdiagnosis showed significant improvement on the posttest. The concepts of patient safety, just culture, and safely doing less can be introduced to learners at a formative stage in their career through simulation.
| S-EPMC6342435 | biostudies-literature
Project description:IntroductionPulseless ventricular tachycardia is an uncommon presentation to the pediatric emergency department (ED) or the pediatric ICU (PICU); however, if unrecognized or inappropriately treated, it can lead to significant morbidity and mortality. This resource was created to simulate a high-acuity and low-frequency event targeting PICU fellows, pediatric emergency medicine fellows, pediatric residents, ED residents, medical students, and advanced nursing providers.MethodsThis scenario details the case of a 12-year-old boy with a history of heart transplant who presents with the chief complaint of dizziness. He initially has multiple premature ventricular contractions and then progresses to pulseless ventricular tachycardia due to acute rejection. This simulation may be performed in a simulation lab or in situ in the ICU or ED. Necessary personnel include a simulation technician, instructors, and a nurse. A code cart and defibrillator with hands-free pads appropriate for the mannequin are needed supplies. Critical actions include cardiopulmonary resuscitation, defibrillation with three shocks, and administration of anti-arrhythmic. At the end of the scenario, a formal debriefing and learner assessment with structured feedback are performed.ResultsApproximately 110 learners have completed this module during 18 separate sessions. Written evaluation from participants (n = 94) using a Likert scale (1 = not at all, 4 = to a great extent) shows that the objectives of the simulation are met to a great extent, with an average score of 3.8.DiscussionIn conclusion, this resource advances learner knowledge and comfort when managing a pediatric patient with pulseless ventricular tachycardia, reviews appropriate management, and helps identify knowledge deficits in the management of these patients.
| S-EPMC6464469 | biostudies-literature
Project description:IntroductionEarly formal instruction in procedural skills may increase the frequency with which residents perform procedures in the clinical setting. This workshop trained internal medicine residents in ultrasound skills and manual skills required to perform procedures common on medicine wards and required for board eligibility.MethodsSince 2016, our internal medicine residency program has executed three annual half-day workshops for interns during orientation, before clinical duties began. Prior to the workshop, we directed interns to relevant educational resources in the form of online modules and videos. At the workshop, trainees rotated in small groups through facilitated stations to learn basics of procedural ultrasound and to practice manual tasks performed during paracentesis, thoracentesis, lumbar puncture, and peripheral intravenous catheter placement. We administered questionnaires before and immediately after the workshop and used Wilcoxon signed rank tests to compare self-assessed independence and confidence.ResultsTwo hundred four interns with little prior procedural training participated in the workshop. Most participants (85%) indicated that orientation was the best timing for this training experience when compared to later options. Confidence and independence increased for ultrasound-marked thoracentesis, paracentesis, and peripheral intravenous catheters and for lumbar puncture without ultrasound.DiscussionThis internal medicine intern orientation workshop on procedures and procedural ultrasound was well received and increased participants' confidence and sense of independence. This publication contains materials needed to reproduce the training experience.
| S-EPMC7331964 | biostudies-literature
Project description:BackgroundPancreatojejunostomy (PJ) is one of the most difficult and challenging abdominal surgical procedures. There are no appropriate training systems available outside the operating room (OR). We developed a structured program for teaching PJ outside the OR. We describe its development and results of a pilot study.MethodsWe have created this structured program to help surgical residents and fellows acquire both didactic knowledge and technical skills to perform PJ. A manual was created to provide general knowledge about PJ and the specific PJ procedure used in our institution. Based on questionnaires completed by trainers and trainees, the procedure for PJ was divided into twelve steps and described in detail. After creating the manual, we developed organ models, needles and a frame box for simulation training. Three residents (PGY3-5) and three fellows (PGY6 or above) participated in a pilot study. Objective and subjective evaluations were performed.ResultsTrainees learn about PJ by reading the procedure manual, acquiring both general and specific knowledge. We conducted simulation training outside the OR using the training materials created for this system. They simulate the procedure with surgical instruments as both primary and assistant surgeon. In this pilot study, as objective assessments, the fellow-group took less time to complete one anastomosis (36 min vs 48 min) and had higher scores in the objective structured assessment of technical skill (average score: 4.1 vs 2.0) compared to the resident-group. As a subjective assessment, the confidence to perform a PJ anastomosis increased after simulation training (from 1.6 to 2.6). Participants considered that this structured teaching program is useful.ConclusionWe developed a structured program for teaching PJ. By implementing this program, learning opportunities for surgical residents and fellows can be increased as a complement to training in the OR.
| S-EPMC7908720 | biostudies-literature
Project description:BackgroundPain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested.MethodsHalf of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions.ResultsThis study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication.ConclusionsTraining with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.
| S-EPMC7905916 | biostudies-literature
Project description: Not available
| S-EPMC8719362 | biostudies-literature