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Developments in Simulation Bronchoscopy Training  [PDF]
Jack A. Kastelik, Faiza Chowdhury, Sega Pathmanathan, Imran Aslam, Joseph Hogg, Jaymin B. Morjaria
Open Journal of Respiratory Diseases (OJRD) , 2013, DOI: 10.4236/ojrd.2013.34024
Abstract: Flexible bronchoscopy is a common procedure. Training in bronchoscopy is a complex process involving learning technical skills, understanding indications and contraindications, risks and benefits of the procedure, working within the team and communicating with patients. It is expected that a competent bronchoscopist is able to maneuver the scope through the anatomically complex bronchial tree, take samples, manage the sedated patient and communicate with nursing staff. Learning the complex procedural skills in the clinical setting can be stressful, therefore current bronchoscopic training methodology should blend a number of learning methods including didactic lectures, web-based material, high and low fidelity simulators as well as supervised apprenticeship training. Simulation-based bronchoscopy training therefore has been explored as a mode of training bronchoscopy skills. In this article, the role of simulation-based bronchoscopy training is reviewed. The low fidelity and high fidelity virtual reality bronchoscopy models are described together with the evidence available to support the use of simulation for bronchoscopy training.
Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia  [PDF]
Ankeet D. Udani,Alex Macario,Kiruthiga Nandagopal,Maria A. Tanaka,Pedro P. Tanaka
Anesthesiology Research and Practice , 2014, DOI: 10.1155/2014/659160
Abstract: Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum ( ). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group ( ). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear. 1. Introduction Research in expert performance identifies deliberate practice as the hallmark of superior performance. Deliberate practice training as described by Ericsson and colleagues entails (1) motivated learners, (2) well-defined learning objectives, (3) precise measurements of performance, (4) focused and repetitive practice, and (5) informative real-time feedback concerning performance [1]. Deliberate practice has been shown to be effective in increasing performance skills in various domains including music, sports, and games such as chess and typing [2, 3]. Recently, educators in science and medicine have been using principles of deliberate practice to design training modules in an attempt to improve student performance [4]. Simulation technologies in particular have been used in the deliberate practice of procedural skills at the graduate medical education level as there is opportunity for repeated practice and immediate feedback in controlled, safe, representative scenarios. Simulation-based instruction of procedural skills in medicine is becoming widespread. Simulation-based medical education has been shown to increase knowledge, provide opportunities for practice, and allow for assessment
Subcutaneous Dissociative Conscious Sedation (sDCS) an Alternative Method of Anesthesia for Fiberoptic Bronchoscopy  [PDF]
Mihan J. Javid, Zoha Alinejad, Asghar Hajipour, Zahra Khazaeipour
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.57027
Abstract: Objective: Current randomized clinical trial was conducted to compare the efficacy and side effects of dissociative conscious sedation and conscious sedation in patients under bronchoscopy. Methods: In this randomized clinical trial, 110 patients scheduled for Fiberoptic Bronchoscopy in a training hospital in 2012 were enrolled and randomly assigned to receive either SC ketamine plus IV fentanyl (dissociative conscious sedation) or placebo plus IV fentanyl (conscious sedation) and the efficacy and side effects were assessed and compared. Results: There was significant difference between systolic and diastolic blood pressure and heart rate in two groups and more stability was shown in dissociative conscious sedation group (P < 0.05). Also the incidence of cough, the need to extra dose of fentanyl and recall showed less frequency in dissociative conscious sedation group (P < 0.05). Conclusions: Totally, according to the obtained results, it may be concluded that Subcutaneous Dissociative Conscious Sedation (sDCS) in comparison to Conscious Sedation is significantly more efficient accompanied by less side effects in fiberoptic bronchoscopy and using this method is recommended. Implication of the Manuscript: The study was designed in order to evaluate the efficacy of subcutaneous Dissociative Conscious Sedation (sDCS) Method in fiberoptic bronchoscopy.
Fellows as teachers: a model to enhance pediatric resident education  [cached]
Carl H. Backes,Kris M. Reber,Jennifer K. B. Trittmann,Hong Huang
Medical Education Online , 2011, DOI: 10.3402/meo.v16i0.7205
Abstract: Pressures on academic faculty to perform beyond their role as educators has stimulated interest in complementary approaches in resident medical education. While fellows are often believed to detract from resident learning and experience, we describe our preliminary investigations utilizing clinical fellows as a positive force in pediatric resident education. Our objectives were to implement a practical approach to engage fellows in resident education, evaluate the impact of a fellow-led education program on pediatric resident and fellow experience, and investigate if growth of a fellowship program detracts from resident procedural experience.This study was conducted in a neonatal intensive care unit (NICU) where fellows designed and implemented an education program consisting of daily didactic teaching sessions before morning clinical rounds. The impact of a fellow-led education program on resident satisfaction with their NICU experience was assessed via anonymous student evaluations. The potential value of the program for participating fellows was also evaluated using an anonymous survey.The online evaluation was completed by 105 residents. Scores were markedly higher after the program was implemented in areas of teaching excellence (4.44 out of 5 versus 4.67, p<0.05) and overall resident learning (3.60 out of 5 versus 4.61, p<0.001). Fellows rated the acquisition of teaching skills and enhanced knowledge of neonatal pathophysiology as the most valuable aspects of their participation in the education program. The anonymous survey revealed that 87.5% of participating residents believed that NICU fellows were very important to their overall training and education.While fellows are often believed to be a detracting factor to residency training, we found that pediatric resident attitudes toward the fellows were generally positive. In our experience, in the specialty of neonatology a fellow-led education program can positively contribute to both resident and fellow learning and satisfaction. Further investigation into the value of utilizing fellows as a positive force in resident education in other medical specialties appears warranted.
Resident psychiatrists as assessors for lectures in continued medical education in psychiatry  [cached]
Melamed Yuval,Ophir Gil,Nechama Yael,Abramovitzh Ruth
Indian Journal of Medical Sciences , 2006,
Abstract: OBJECTIVES: We examined the quality of instruction in a continued medical education course and the correspondence between the residents and lecturers evaluations of the program. MATERIALS AND METHODS : Resident psychiatrists and instructors completed structured evaluation forms immediately following each lecture in a psychiatry course for one academic year. RESULTS : Residents′ and lecturers′ evaluations of goal achievement, but not general ratings of lecture quality correlated positively. Instructors′ enthusiasm, clarity and appropriateness of subject matter and encouragement of independent thinking, but not audio-visual aids significantly correlated with resident′s positive evaluations. CONCLUSIONS : Ongoing evaluation of classroom lectures by resident psychiatrists may provide valuable feedback to instructors and impact the quality of medical education. The "classic" role of the teacher organization and enthusiasm are the most important components of quality education.
Resident Physician Attitudes and Competence About Obesity Treatment: Need for Improved Education
Nichola J. Davis M.D., M.S,Himani Shishodia, M.D,Bizath Taqui, M.D,Claudia Dumfeh, B.S
Medical Education Online , 2008,
Abstract: Background: Obesity is a common problem in primary care, but little is known about Internal Medicine residents’ attitudes towards obesity treatment.Objective: To describe resident attitudes about obesity treatment.Methods: Cross-sectional survey of 101 Internal Medicine residents in Philadelphia, PA, and Bronx, NY. Responses to 18 items on a Likert scale assessed resident attitudes. Weight loss goals were assessed with open-ended questions to a clinical scenario. ANOVA with trend analysis compared questionnaire responses to resident postgraduate year (PGY) level. Associations between clinic site, PGY level, and dichotomized Likert responses were tested with chi-square analysis.Results: 19% of residents felt competent in prescribing weight loss programs. Few residents (18%) considered the current recommendations of a 5-10% reduction in body weight to be successful in an obese hypothetical patient. Third-year residents reported greater feelings of negativity towards obese patients than first- and second year residents (p<.05)Conclusions: Resident physicians do not feel competent in treating obesity and have unrealistic weight loss goals; third-year residents had more negative attitudes about obese patients compared to residents in their 1st or 2nd year of training. These areas are targets for further resident education about obesity management.
Professional Staffing Practice of Academic Anesthesia Departments in the United States  [PDF]
Steven Ginsberg,Jonathan Kraidin,Christopher Gallagher,Don R. Hoover
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.34055
Abstract: Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.
Professionalism education of OB/GYN resident physicians: What makes a difference?  [PDF]
Brett Worly
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.31A026
Abstract:

Objective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Support Group (PDSG) programs. Methods: 32 OB/GYN residents participated in this IRB approved pilot study. Twenty residents were assessed with the Barry Challenges to Professionalism Questionnaire (Barry), the Jefferson Scale of Empathy-Physician Version (JSE), and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAT) in August 2010, as controls. Five Narrative Medicine sessions and four PDSG sessions were then used from August 2010-May 2011, for resident physician professionalism education. Seventeen residents then underwent post-testing with the Barry, JSE, and JSAT in May 2011. Results: The pre-test/post-test Barry comparison showed an improvement in scores after introduction of the new Narrative Medicine and PDSG curriculum (7.6 +/- 2.1 versus 8.4 +/- 1.6; p = 0.10) though this was not statistically significant. Pre-test/post-test comparison of JSAT scores showed a statistically significant decline in collaboration (52.3 +/- 4.1 versus 49.7 +/- 3.7; p = 0.028) while JSE scores showed a downward trend in empathy (109.3 +/- 10.0 versus 104.8 +/- 9.2; p = 0.086). Conclusion: Narrative Medicine and PDSG small group sessions could be an effective component of OB/GYN resident physician Professionalism curriculum. This pilot project was underpowered, due to limited resources.

High-Fidelity Patient Simulation: Future of Anesthesia Education  [cached]
Roderick Cheung
University of Toronto Medical Journal , 2008, DOI: 10.5015/utmj.v85i2.224
Abstract:
Influence of Resident Education in Correctly Diagnosing Extremity Soft Tissue Sarcoma  [PDF]
Vignesh K. Alamanda,Samuel N. Crosby,Shannon L. Mathis,Kristin R. Archer,Kyla P. Terhune,Ginger E. Holt
Sarcoma , 2013, DOI: 10.1155/2013/679323
Abstract: Background. One-third of all extremity soft tissue sarcomas are misdiagnosed and inappropriately excised without proper preoperative diagnosis and planning. This study aimed at examining the clinical judgment of residents in both general and orthopaedic surgery and at determining whether resident education plays a role in appropriately managing unknown soft tissue masses. Methods. A case-based survey was used to assess clinical decisions, practice patterns, and demographics. Aggregate response for all of the clinical cases by each respondent was correlated with the selections made for practice patterns and demographic data. Results. A total of 381 responses were returned. A higher percentage of respondents from the orthopaedic group (84.2%) noted having a dedicated STS rotation as compared to the general surgery group (35.8%) . Depth, size, and location of the mass, rate of growth, and imaging characteristics were considered to be important factors. Each additional year of training resulted in 10% increased odds of selecting the correct clinical decision for both groups. Conclusion. Our study showed that current residents in both orthopaedic surgery and general surgery are able to appropriately identify patients with suspicious masses. Continuing education in sarcoma care should be implemented beyond the years of residency training. 1. Introduction Soft tissue sarcomas (STS) are highly malignant and rare tumors with an incidence of about 1 in every 100,000 patients [1]. In contrast, their benign counterparts are much more common with an incidence of about 300 in every 100,000 patients [2]. The relatively high incidence of benign soft tissue neoplasms as compared to malignant STS results in many incomplete excisions of STS without adequate preoperative planning, biopsy, and imaging. At our institution, approximately two-third of patients present for a primary resection while the remaining one-third present for a re-resection of an incompletely excised tumor. These unplanned excisions often leave positive surgical margins and necessitate a much larger repeat excision to obtain clear surgical margins. This subsequently results in greater emotional tolls, higher costs, and inferior functional outcomes [3]. While it is well established that STS are often mistakenly excised under the pretense of a benign tumor, it is not completely known how the physician’s graduate medical education training plays a role in this. In an attempt to understand this further, we administered a case-based sarcoma survey that assessed the respondent is clinical decision making
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