Influence of simulation in Malaysian healthcare education and research (ISIM-HERE): a two-decade experience

The use of simulation as a teaching methodology in medical institutions has been in Malaysia for over two decades. This study aimed to evaluate the current scenarios of simulation impact and utilization in Malaysian academic healthcare institutions (AHIs). We conducted a population-based survey on all AHIs in Malaysia including public and private. We performed an online survey followed by a face-to-face interview evaluating the number of institutions that used simulation, duration of experience, purpose, funding, users’ category and healthcare domain, research activities, dedicated-trained staff and the challenges faced. Out of 75 healthcare institutions approached, 38 agreed to participate in this study. Twenty-two (57.9%) were public hospitals while 16 (42.1%) were private institutions. Thirty-five (92.1%) out of 38 institutions used simulation as a teaching method. The majority (15, 42.9%) had less than five years’ experience, and about a third (11, 31.4%) used simulation for teaching, training and performance assessment. Nurses (30, 26.1%) were the main users followed by physicians and paramedic (19, 16.5% each respectively). In-hospital and procedural group were the top two domains of utilizers. Almost three quarters (25, 71.4%) have dedicated support staff to manage the centre. Funding was mainly from internal institutional support mechanisms. Seven different categories of challenges were identified, the biggest being financial support. In summary, even though healthcare simulation has been in Malaysia for the past two decades but the most substantial impact happened over the last five years. Utilization was mainly for teaching, training, and performance assessment with minimal use in research

Making Jobs Good

A series of earlier CEPR reports documented a substantial decline over the last three decades in the share of "good jobs" in the U.S. economy. This fall-off in job quality took place despite a large increase in the educational attainment and age of the workforce, as well as the productivity of the average U.S. worker.This report evaluates the likely impact of several policies that seek to address job quality, including universal health insurance, a universal retirement system (over and above Social Security), a large increase in college attainment, a large increase in unionization, and gender pay equity

Has Education Paid Off for Black Workers?

Over the past three decades, the "human capital" of the employed black workforce has increased enormously. In 1979, only one-in-ten (10.4 percent) black workers had a four-year college degree or more. By 2011, more than one in four (26.2 percent) had a college education or more. Over the same period, the share of black workers with less than a high school degree fell from almost one-third (31.6 percent) to only about one in 20 (5.3 percent). The black workforce has also grown considerably older. In 1979, the median employed black worker was 33 years old; today, the median is 39. Economists expect that increases in education and work experience will increase workers' productivity and translate into higher compensation. But, the share of black workers in a "good job" -- one that pays at least $19 per hour (in inflation-adjusted 2011 dollars), has employer-provided health insurance, and an employer-sponsored retirement plan -- has actually declined. This paper looks at this trend and policies that would have a large, positive impact on the quality of jobs for black workers

Escaping the Shadow of Malpractice Law

Abinovich-Einy addresses several constituencies operating at the meeting point of alternative dispute resolution (ADR), communication theory, healthcare policy, and medical-malpractice doctrine. From an ADR perspective, the need for, and barriers to, addressing non-litigable disputes, for which the alternative route is the only one, is explored. It is shown that ADR mechanisms may not take root when introduced into an environment that is resistant to collaborative and open discourse without additional incentives and measures being adopted

Escaping the Shadow of Malpractice Law

Abinovich-Einy addresses several constituencies operating at the meeting point of alternative dispute resolution (ADR), communication theory, healthcare policy, and medical-malpractice doctrine. From an ADR perspective, the need for, and barriers to, addressing non-litigable disputes, for which the alternative route is the only one, is explored. It is shown that ADR mechanisms may not take root when introduced into an environment that is resistant to collaborative and open discourse without additional incentives and measures being adopted

Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

Wearable proximity sensors for monitoring a mass casualty incident exercise: a feasibility study

Over the past several decades, naturally occurring and man-made mass casualty incidents (MCI) have increased in frequency and number, worldwide. To test the impact of such event on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardised method to collect and analyse data from mass casualty exercises is needed, in order to assess preparedness and performance of the healthcare staff involved. We report on the use of wearable proximity sensors to measure proximity events during a MCI simulation. We investigated the interactions between medical staff and patients, to evaluate the time dedicated by the medical staff with respect to the severity of the injury of the victims depending on the roles. We estimated the presence of the patients in the different spaces of the field hospital, in order to study the patients' flow. Data were obtained and collected through the deployment of wearable proximity sensors during a mass casualty incident functional exercise. The scenario included two areas: the accident site and the Advanced Medical Post (AMP), and the exercise lasted 3 hours. A total of 238 participants simulating medical staff and victims were involved. Each participant wore a proximity sensor and 30 fixed devices were placed in the field hospital. The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by participants. We obtained contact matrices based on cumulative time spent in proximity between victims and the rescuers. Our results showed that the time spent in proximity by the healthcare teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with triage code and diagnosis, and no obvious bottlenecks were found

Advancing Care Excellence for Seniors: Reflections on a John A. Hartford Foundation-funded Nursing Education Program

This brief will describe the work and assess the impact of the NLN Advancing Care Excellence for Seniors initiative, or ACE.S, which the John A. Hartford Foundation supported from 2009 to 2012. ACE.S was the first national effort to prepare students in all pre-licensure nursing programs, including associate degree programs, to deliver high-quality care to older adults in a variety of settings, by providing new educational opportunities, teaching tools, and other resources to help pre-licensure nursing faculty offer geriatric content and understanding to their students