The Ethics of Teaching Physicians Electronic Fetal Monitoring: And Now for the Rest of the Story.
Ontology highlight
ABSTRACT:
SUBMITTER: Sartwelle TP
PROVIDER: S-EPMC5553489 | biostudies-other | 2017 Jan
REPOSITORIES: biostudies-other
Similar Datasets
Project description: Not available
| S-EPMC1180660 | biostudies-literature
Project description:BACKGROUND:There is a pressing need for policy makers to demonstrate progress made on investments in prevention, but few examples of monitoring systems capable of tracking population-level prevention policies and programs and their implementation. In New South Wales, Australia, the scale up of childhood obesity prevention programs to over 6000 childcare centres and primary schools is monitored via an electronic monitoring system, "PHIMS". METHODS:Via a focussed ethnography with all 14 health promotion implementation teams in the state, we set out to explore what aspects of program implementation are captured via PHIMS, what aspects are not, and the implications for future IT implementation monitoring systems as a result. RESULTS:Practitioners perform a range of activities in the context of delivering obesity prevention programs, but only specific activities are captured via PHIMS. PHIMS thereby defines and standardises certain activities, while non-captured activities can be considered as "extra" work by practitioners. The achievement of implementation targets is influenced by multi-level contextual factors, with only some of the factors accounted for in PHIMS. This evidences incongruencies between work done, recorded and, therefore, recognised. CONCLUSIONS:While monitoring systems cannot and should not capture every aspect of implementation, better accounting for aspects of context and "extra" work involved in program implementation could help illuminate why implementation succeeds or fails. Failure to do so may result in policy makers drawing false conclusions about what is required to achieve implementation targets. Practitioners, as experts of context, are well placed to assist policy makers to develop accurate and meaningful implementation targets and approaches to monitoring.
| S-EPMC7291504 | biostudies-literature
Project description:Electronic fetal monitoring (EFM) entered clinical medical practice at the same time bioethics became reality. Bioethics changed the medical ethics landscape by replacing the traditional Hippocratic benign paternalism with patient autonomy, informed consent, beneficence, and nonmaleficence. But EFM use represents the polar opposite of bioethics' revered principles-it has been documented for half a century to be completely ineffectual, used without informed consent, and harmful to mothers and newborns alike. Despite EFM's ethical misuse, there has been no outcry from the bioethical world. Why? This article answers that question, discussing EFM's history and the reasons it was issued an ethics pass. And it explores the reason that even today mothers are still treated with blatant medical paternalism, deprived of autonomy and informed consent, and subjected to real medical risks under the guise that EFM is an essential safety device when in fact it is used almost solely to protect physicians and hospitals from cerebral palsy lawsuits.
| S-EPMC5530627 | biostudies-other
Project description:IntroductionEthics is an integral component of child and adolescent psychiatry. While ethics can seem abstract or philosophical, its tenets are fundamental to the practice of medicine. Understanding relevant ethical principles shapes how practitioners make decisions in all activities, including clinical, administrative, research, and scholarly.MethodsUsing the American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics as the framework, these vignettes serve as stimulus material to help teach the ethical principles relevant to child and adolescent psychiatry practice. Each vignette briefly describes a clinical situation in practice, followed by questions and possible appropriate responses. The teacher's guide includes a discussion of the relevant ethical principles and perspectives on how to think about the issues involved. A supplementary overview of ethical issues in child and adolescent psychiatry and a list of resources are also provided.ResultsWe and other child and adolescent psychiatrists have used this curriculum at professional organizational meetings, in residency programs, and in teaching medical students with positive learner responses.DiscussionThis curriculum was developed by members of the AACAP Ethics Committee with input from the entire committee in an effort to produce material that was easy to use and provided valuable content about an essential aspect of practice that is relevant to all practitioners at all levels. While designed for child and adolescent psychiatrists, the content is relevant to all physicians working with children, adolescents, and families.
| S-EPMC6464473 | biostudies-literature
Project description:Introduction:Delivering unexpected news to families can lead to emotionally charged conversations that cause discomfort and feelings of ineffectiveness in pediatric postgraduate trainees. Although prenatal screening exists, over 80% of trisomy 21 diagnoses continue to be made postnatally to unsuspecting parents who report a desire for better communication from health care professionals when they first receive the news of their child's diagnosis. Recognizing this area for improvement as reported in the literature, as well as the expressed desire from fellows in the University of Ottawa neonatal-perinatal medicine program for additional protected time to preemptively practice such disclosures, this trisomy 21 Scenario-Oriented Learning in Ethics workshop was developed. Methods:During the workshop, trainees are introduced to an evidence-based communication framework that provides them with strategies to facilitate clear knowledge translation and promote rapport with families for this specific clinical scenario. Participants are divided into small groups and practice disclosing a trisomy 21 diagnosis to a standardized patient in the role of a new mother. Each small group is supported by two trained facilitators who are experts in delivering life-altering news. Results:The pilot workshop was completed by 21 postgraduate trainees from the University of Ottawa. Qualitative evaluations were overwhelmingly positive, with feedback indicating high levels of perceived usefulness for the workshop. Discussion:By preemptively practicing evidence-based communication, we hope to increase trainee confidence and preparation for trisomy 21 disclosures and improve parents' feelings regarding the quality of communication and support provided while receiving real-life trisomy 21 diagnoses.
| S-EPMC6338174 | biostudies-other
Project description:BackgroundWith the advancement of information technology, teachers have become able to overcome the limitations of time and room capacity by carrying out teaching activities online. This practice, however, also presents new challenges. The present study explores how to fully capitalize on the advantages of online and offline teaching and improve the quality and impact of the teaching delivered. This article presents an analysis of the planning, implementation, evaluation, and reflection process of reforming the Fujian Medical University (FJMU) medical ethics course.MethodsAfter early attempts using the Small Private Online Course (SPOC) and flipped classroom formats, this paper focuses on the comprehensive active implementation of blended teaching practice. In terms of teaching practice, this research makes targeted improvements to overcome the known shortcomings of SPOCs and flipped classrooms, including the significant preparatory workload and lacking enthusiasm for classroom participation, by redesigning the course and evaluation method and changing the role of the teacher in blended teaching. Subsequently, the study used a stratified sampling method to select 20 students enrolled in the clinical medicine course at Fujian Medical University (FJMU). Their course experience was investigated using a semi-structured interview. Interview content related to evaluating teaching effect was extracted and encoded for subsequent qualitative analysis.ResultsA qualitative analysis of the student evaluation of blended teaching as implemented on the medical ethics course showed that the main factors influencing student engagement are the method of assigning tasks and that of testing learning outcomes. Student participation in class is influenced by the richness of the curriculum resources available and the role played by the teacher.ConclusionThis research presents a discussion of blended teaching and suggests improvements that can be made to address low student engagement and poor classroom participation. This round of blended teaching was shown to improve learning autonomy and classroom participation and to support students in the development of their clinical abilities and higher-order thinking skills. These findings provide a reference for the implementation of online teaching during the COVID-19 pandemic.
| S-EPMC9094735 | biostudies-literature
Project description:ObjectiveIn 2015, new FIGO guidelines for CTG interpretation were presented (FIGO-15). In 2017, the previous Swedish guidelines (SWE-09) were replaced with guidelines adapted to FIGOs (SWE-17). The performance of these three templates had not been scientifically evaluated before its clinical implementation. The objective of this study was to compare the sensitivity and specificity to detect fetal acidosis at birth using these three templates during the second stage of labor.Study designThis case-control study included 295 neonates with cord blood pH < 7.05 and 591 controls with pH ≥ 7.15, born 2012-2017. Tracings from the last 30-80 min of labor were classified independently by three assessors (midwives, residents and obstetricians), blinded to group and outcome.ResultsThe classification pathological using FIGO-15 had a sensitivity of 50 % and specificity of 88 % in detecting fetuses with acidosis. For SWE-17, the sensitivity was 62 % and the specificity 85 %. For SWE-09 the sensitivity was 87 % and the specificity 56 %.By combining suspicious and pathological patterns the sensitivity for FIGO-15 increased to 97 %, and for SWE-17 to 83 %, whereas the specificity decreased to 23 % and 68 % respectively.ConclusionsThe FIGO classification seemed to be insufficiently discriminative in the second stage of labor; most patterns in acidotic cases were classified as merely suspicious with this template, and the sensitivity of pathological patterns was low at 50 %. Combined pathological and suspicious patterns detected fetal acidosis at a specificity that was too low to be useful (23 %). SWE-09 showed the best ability to detect acidosis with pathological patterns (sensitivity 87 %). SWE-17 reached almost the same sensitivity (83 %) with the combination of suspicious and pathological patterns, and at a higher specificity (68 %).
| S-EPMC7724159 | biostudies-literature
Project description:Background Sub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best. Objectives Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525). Search strategy CENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched. Selection criteria Primary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate. Data collection and analysis Data were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE. Main results Sixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited. Conclusions Given the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice. Tweetable abstract Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes. Tweetable abstract Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.
| S-EPMC8359372 | biostudies-literature
Project description:IntroductionThere is a need for innovative workshops designed to teach students and residents the basics of clinical medical education. Resident physicians often spend a significant portion of their training teaching others and frequently have very little formal instruction on teaching techniques. Other teaching tools exist but are often either entirely lecture based or too extensive to easily incorporate into a residency teaching session. There is a need for the facilitated practice of teaching methods to improve the resident educational experience.MethodsThis 80-minute workshop blends interactive role-play case studies with quick lectures on the ARCH feedback model, the RIME model of medical information mastery, and the One-Minute Preceptor. This workshop includes three short PowerPoint lectures, four case studies, a handout, a pre-/posttest, and a session evaluation form.ResultsResident and student learners were engaged for the entirety of this session. Pre-/posttest results showed an improvement in understanding of basic teaching and feedback techniques, and survey results showed a higher likelihood of the learners wanting to incorporate teaching into their future practice.DiscussionThis workshop is quick and overall quite effective in teaching basic feedback and teaching techniques. It provides a much-needed opportunity for residents to practice teaching techniques immediately after they have learned the concepts. This training is ideal for a residency program looking to provide new senior residents with the teaching tools they need for success.
| S-EPMC7394347 | biostudies-literature
Project description:IntroductionPeer learning and near-peer teaching have been described in many specialties, less so in Radiology. We present near-peer teaching whereby residents present a series of didactic sessions at the course outset in the form of "symposia" and perform a scholarly activity in the form of teaching. We aim to demonstrate how near-peer teaching in symposia front-loaded within an introductory radiology course can improve medical student satisfaction.MethodA total of 169 students were enrolled over a period of 3 years, 55 before (2017-2018) and 114 (2018-2020) after the introduction of the symposium. Anonymous course evaluations were collected from all students. In addition, 240 fourth-year medical students who also attended symposium lectures received satisfaction surveys in 2019 and 2020.ResultsAll (169/169, 100%) students taking the course evaluated it. Overall evaluation scores rose from 8.3/10 to 9.0/10 post-symposia. Among student satisfaction surveys, 89/240 (37%) specifically commented on symposia; 91% (80/89) of those found symposia very or extremely informative. 29/71 (41%) of all residents were able to participate in the symposia, 20/29 in multiple years throughout residency, allowing them to fulfill the Accreditation Council for Graduate Medical Education interpersonal and communication skills core competencies and meet scholarly activity requirements.ConclusionNear-peer teaching in the form of resident-taught interactive didactics grouped in symposia can have a positive outcome on medical student satisfaction.
| S-EPMC9996712 | biostudies-literature