Narrative, written sign-outs and interns' and senior medical students' confidence: a randomized, controlled crossover trial.
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ABSTRACT:
SUBMITTER: Chuang E
PROVIDER: S-EPMC3312534 | biostudies-other | 2012 Mar
REPOSITORIES: biostudies-other
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Project description:Antimicrobial resistance (AMR) is a major public health problem in India. We surveyed medical students to assess their knowledge, attitudes, and factors associated with confidence in antibiotic prescribing intent. In this cross-sectional study, a convenience sample of 356 students were surveyed in July-August 2017 on AMR-related knowledge, attitudes, information sources and antimicrobial training. Antimicrobial resistance knowledge and attitude scores were calculated. Bivariate analysis using the chi-square test of independence and multivariate binary logistic regression analysis were used to investigate factors associated with confidence in antibiotic prescribing intent. A total of 347 students completed the survey; 64% agreed that strong knowledge of antibiotics is important in their medical careers; 61% stated that they would like more education regarding appropriate use of antibiotics. The mean total knowledge score was 11.5 out of 31 (SD = 3.4), and the mean attitude score was 6.0 out of 16 (SD = 4.2). Although 13% of students were "very familiar"/"familiar" with the term "antimicrobial stewardship," only 35% of students felt "very confident" or "confident" in antimicrobial prescribing to patients in the future. On multivariate analysis, female gender, clinical vignette antimicrobial knowledge scores, positive attitude scores, awareness of Infection Control Policy, and > 3 years of antimicrobial prescribing clinical training were predictors of confidence in antimicrobial prescribing. A higher attitude score was independently associated with decreased confidence in antimicrobial prescribing intent. There is a need to improve education regarding AMR in the curriculum, and increase awareness of infection control policies and antimicrobial stewardship program in clinical settings.
| S-EPMC7695085 | biostudies-literature
Project description:IntroductionCross-cover, the process by which a nonprimary team physician cares for patients, usually during afternoons, evenings, and weekends, is common in academic medical centers. With the advent of residency duty-hour restrictions, cross-cover care has increased, making education in effective cross-coverage an urgent need.MethodsWe implemented a cross-cover didactic activity composed of 18 interactive cases with 29 senior medical students enrolled in an internal medicine residency preparation course. The curriculum was facilitated by one faculty member and one senior medical resident and utilized think-pair-share learning techniques to discuss an approach to a range of common (both urgent and routine) cross-cover scenarios. We analyzed confidence and feelings of preparedness pre- and postintervention. We also examined differences in medical knowledge based on two multiple-choice written cross-cover cases that addressed both medical management and triage.ResultsThis curriculum significantly improved feelings of confidence (from 1.8 to 3.2, p < .0001), reduced anxiety (from 4.5 to 4.1, p < .03), and improved performance in clinical case scenarios (from 82% to 89%, p < .02).DiscussionThis curriculum covered not only the important medical aspects of cross-cover care (e.g., diagnostics and management) but also equally important roles of cross-cover, such as how to effectively triage cross-cover scenarios. The curriculum was well received by students.
| S-EPMC7431185 | biostudies-literature
Project description:Objectives:To gain insight into factors affecting career preference and career choice during the final phase of medical school, above and beyond a model that was presented by Bland and colleagues in 1995 (the "Bland model"). Methods:A qualitative study was conducted. One-hour semi-structured interviews were conducted with final-year medical students about career preference and the factors influencing preference and choice. The interviews were transcribed and a thematic analysis was applied, to identify patterns and interrelationships in the data and to compare and contrast these with the Bland model. Results:Twenty-four students participated. Three critical sets of factors, not present in the Bland model, emerged from the interviews: (a) factors arising from student-initiated information collection, (b) patient population characteristics of a specialty domain, and (c) the characteristics of teams and colleagues within a specialty. Conclusions:Students appear to actively match and calibrate perceptions of different specialty characteristics with their current personal needs and expected future needs, and to include cues from self-initiated information collection about a speciality. This agency aligns with Billett's workplace learning theory. Next, specialty patient population features appear to be taken into account; this was not unexpected but not included in the Bland model. Finally, the characteristics of teams and colleagues of a specialty were stressed in the interviews. These three components broaden the applicability of the Bland model--originally created for primary-care careers--to medical specialties in general.
| S-EPMC6387763 | biostudies-other
Project description:ObjectiveEffective sign-outs involve verbal communication supported by written or electronic documentation. We investigated the clinical content overlap between sign-out documentation and face-to-face verbal sign-out communication.MethodsWe audio-recorded resident verbal sign-out communication and collected electronically completed ("written") sign-out documentation on 44 sign-outs in a General Medicine service. A content analysis framework with nine sign-out elements was used to qualitatively code both written and verbal sign-out content. A content overlap framework based on the comparative analysis between written and verbal sign-out content characterized how much written content was verbally communicated. Using this framework, we computed the full, partial, and no overlap between written and verbal content.ResultsWe found high a high degree of full overlap on patient identifying information [name (present in 100% of sign-outs), age (96%), and gender (87%)], past medical history [hematology (100%), renal (100%), cardiology (79%), and GI (67%)], and tasks to-do (97%); lesser degree of overlap for active problems (46%), anticipatory guidance (46%), medications/treatments (15%), pending labs/studies/procedures (7%); and no overlap for code status (<1%), allergies (0%) and medical record number (0%).Discussion and conclusionThree core functions of sign-outs are transfer of information, responsibility, and accountability. The overlap-highlighting what written content was communicated-characterizes how these functions manifest during sign-outs. Transfer of information varied with patient identifying information being explicitly communicated and remaining content being inconsistently communicated. Transfer of responsibility was explicit, with all pending and future tasks being communicated. Transfer of accountability was limited, with limited discussion of written contingency plans.
| S-EPMC6951999 | biostudies-literature
Project description:Emergency departments (EDs) offer a variety of learning opportunities for undergraduate medical students. It is however, difficult to evaluate whether they are receiving recommended training during their emergency medicine (EM) clerkship without identifying their clinical activities. We aimed to evaluate the clinical exposure of the final year medical students at our College during their EM clerkship.This is a retrospective analysis of prospectively collected student logbooks. 75 students rotated in a 4-week EM clerkship during 2015-2016. The students rotated in EDs of two hospitals. Each ED treats more than 120,000 cases annually. The students completed 12 eight-hours shifts. Presentations and procedures seen were compared with EM curriculum recommendations.Five thousand one hundred twenty-two patient presentations and 3246 procedures were recorded in the logbooks, an average (SD) of 68.3 (17.6) patients and 46.1 (14.0) procedures. None of the students encountered all ten recommended presentations. Two students (2.6%) logged all nine procedure categories of the EM curriculum.Recommended presentations and procedures of the EM clerkship were not fully encountered by all our students. Different settings vary in the availability and type of patients and procedures. Each clinical clerkship should tailor their teaching methods based on the available learning opportunities.
| S-EPMC5756377 | biostudies-literature
Project description:PurposeDeveloping medical students' clinical reasoning requires a structured longitudinal curriculum with frequent targeted assessment and feedback. Performance-based assessments, which have the strongest validity evidence, are currently not feasible for this purpose because they are time-intensive to score. This study explored the potential of using machine learning technologies to score one such assessment-the diagnostic justification essay.MethodFrom May to September 2018, machine scoring algorithms were trained to score a sample of 700 diagnostic justification essays written by 414 third-year medical students from the Southern Illinois University School of Medicine classes of 2012-2017. The algorithms applied semantically based natural language processing metrics (e.g., coherence, readability) to assess essay quality on 4 criteria (differential diagnosis, recognition and use of findings, workup, and thought process); the scores for these criteria were summed to create overall scores. Three sources of validity evidence (response process, internal structure, and association with other variables) were examined.ResultsMachine scores correlated more strongly with faculty ratings than faculty ratings did with each other (machine: .28-.53, faculty: .13-.33) and were less case-specific. Machine scores and faculty ratings were similarly correlated with medical knowledge, clinical cognition, and prior diagnostic justification. Machine scores were more strongly associated with clinical communication than were faculty ratings (.43 vs .31).ConclusionsMachine learning technologies may be useful for assessing medical students' long-form written clinical reasoning. Semantically based machine scoring may capture the communicative aspects of clinical reasoning better than faculty ratings, offering the potential for automated assessment that generalizes to the workplace. These results underscore the potential of machine scoring to capture an aspect of clinical reasoning performance that is difficult to assess with traditional analytic scoring methods. Additional research should investigate machine scoring generalizability and examine its acceptability to trainees and educators.
| S-EPMC8243833 | biostudies-literature
Project description:IntroductionMedical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios-strong emotion, goals of care, medical error, and palliative care assessment-and utilized formative peer assessment and feedback.MethodsWe created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey.ResultsNinety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included "liked the opportunity to give or receive peer feedback" (46%) and "found the checklists helpful" (45%).DiscussionFeasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.
| S-EPMC8155077 | biostudies-literature
Project description:Evaluation of efforts to support family caregivers of people with dementia in their daily medical management responsibilities requires a measure of caregiver self-efficacy (confidence). This article describes the development and psychometric properties of the Caregiver Confidence in Sign/Symptom Management (CCSM) scale, the only available instrument in this area. Measurement development included literature and expert panel review, cognitive testing, and field testing. The CCSM is a 25-item measure (? = .92) composed of confidence in relation to 4 subscales: knowledge of signs/symptoms (? = .83), management of cognitive signs/symptoms (? = .85), management of medical signs/symptoms (? = .87), and general medication management/responsiveness (? = .85), all of which relate to caregiver role strain. The CCSM is a reliable and valid instrument to assess caregiver confidence in sign/symptom management and is useful to determine caregiver needs and outcomes of related interventions. Additionally, it furthers understanding of the role of self-efficacy in caregiver quality of life.
| S-EPMC5529254 | biostudies-literature
Project description:We report upon the design, content and feedback from an interactive, experiential series of Workshops in Healing for senior medical students. Fifty-six final year medical students enrolled in 2×3?h workshops designed around the core themes of 'physician know thyself' (Workshop 1) and 'confronting suffering' (Workshop 2). Of the 56 students who initially enrolled, 48 students completed both workshops and provided a written open-ended reflection of their learning experience. The study, undertaken over a consecutive 5-year period (2008-2012), employed an emergent, qualitative design using thematic analysis of the reflective comments. We found that the design and content of both workshops promoted transformative learning for these final year medical students. Students identified the following benefits: (1) the opportunity to reaffirm their commitment to their chosen career path; (2) the value of listening to other students share their stories; (3) the importance of the timing of the workshops to occur after exams; (4) the use of various mediums such as art, poetry, music and contemporary/classic literature to present concepts of suffering and healing; and (5) the creation of a safe and confidential space. Students reported that these innovative workshops gave them a renewed sense of drive and enthusiasm for their chosen career. They highlighted the importance of addressing an aspect of medicine (healing) not covered in the traditional medical curriculum. Workshops in Healing helped them to rediscover a deeper meaning to medicine and their roles as future healthcare professionals.
| S-EPMC4251177 | biostudies-literature
Project description:IntroductionInappropriate use of antimicrobials is one of the major modifiable contributors to antimicrobial resistance. There is currently no validated survey tool available to assess knowledge and confidence of medical students in infectious diseases (ID) compared to other diseases states, and little is known about this topic.Materials and methodsA cross-sectional survey of final year medical students attending universities around Australia was conducted between August and September, 2015. A survey unique from other published studies was developed to survey satisfaction in education, confidence and knowledge in ID, and how this compared to these factors in cardiovascular diseases.ResultsReliability and validity was demonstrated in the survey tool used. Students were more likely to rate university education as sufficient for cardiovascular diseases (91.3%) compared to ID (72.5%), and were more confident in their knowledge of cardiovascular diseases compared to ID (74.38% vs. 53.76%). Students tended to answer more cardiovascular disease related clinical questions correctly (mean score 78%), compared to questions on antimicrobial use (mean score 45%).ConclusionsPoor knowledge and confidence amongst final year medical students in Australia were observed in ID. Antimicrobial stewardship agenda should include the provision of additional training in antimicrobial prescribing to the future medical workforce.
| S-EPMC5542537 | biostudies-literature