Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills

revista de Ciências da Arte

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La chasse au trésor

La chasse au trésor raconte l’histoire d’un bâtiment art-déco construit en 1937, au bord d’un lac, dans les Laurentides, au Québec, par l’architecte Antoine Courtens, pour le compte de son compatriote belge l’homme d’affaire Louis Empain. De hasard en accident, de mésaventure en péripéties, le récit factuel de cette histoire fait la part belle à la contingence, faisant apparaître le bâtiment comme un objet architectural résistant aux intentions du commanditaire mises en formes par l’architecte. Les récits recueillis et rapportés, multiplient les approches du bâtiment, lui donnant autant de modes d’existence, parfois incompatibles entre eux. Jusqu’à ce que le mot « communautaire », le qualifiant dès l’origine, fasse retour et s’impose, tel un signifiant maître, donnant une consistance d’objet composite à ces éléments préalablement dispersés.The treasure hunt tells the story of an art-deco building, built in 1937 on the edge of a lake in the Laurentians, Quebec, by architect Antoine Courtens, on behalf of his Belgian compatriot and businessman Louis Empain. From chance to accident, from mishap to adventure, the factual account of this story gives prominence to contingency, making the building appear as an architectural object resisting the architect’s rendering of the client’s intentions. The stories collected and reported multiply the approaches to the building, giving it as many modes of existence, sometimes incompatible between them. Until the word "community", qualifying it from the beginning, comes back and imposes itself, like a master signifier, giving the consistancy of a composite object to these previously dispersed elements

DOCUMENT, FICTION ET DROIT EN ART CONTEMPORAIN

International audienceLe geste artistique consistant à transposer un document et sa valeurtestimoniale de son lieu naturel – celui de l’information et de la vérification– dans le champ de l’art, est fréquent dans l’art moderne et contemporain; il conserve néanmoins à chaque fois quelque chose de sa radicalitéinitiale, qui mérite d’être interrogée afin d’en déplier les effets sans cesserenouvelés. L’équivalence entre geste documentaire et geste artistique,que de nombreux artistes affirment aujourd’hui dans leur travail, conduitelle– par la porosité ainsi créée et par la mise en question générale descatégories –, à la grande indistinction qu’affectionne le système médiatiqueet spectaculaire ? S’agit-il plutôt d’un déplacement de la manièredont faits et fictions se distinguent ?Ces questions font écho à la technique de la fiction juridique inventéepar le droit romain, qui nous propose une manière d’envisager la critiquede la hiérarchie commune en permettant « dans les faits » qu’une fictiondevienne réalité. La stabilité du partage ainsi révoquée, il s’agit maintenant,par différents dispositifs plastiques, d’expérimenter la fiction avecles faits et les faits avec la fiction, comme il s’agit d’expérimenter l’artavec le monde. C’est en croisant des approches artistiques, critiques,philosophiques et juridiques, que cet ouvrage analyse ces effets tant auniveau de l’art lui-même, que des reconfigurations de savoirs qu’il produit,et de notre rapport au Réel

Modeling argon dynamics in first-year sea ice

Sea ice may be an active source or sink for climatically significant gases such as CO2 and CH4. The dynamics of these biogeochemically active gases within sea ice are still not well understood. Modeling can help to identify and calibrate the physical and biogeochemical processes that affect gas production, consumption, diffusion and transport within sea ice. In this study, we aim at constraining the dynamics of carbon dioxide (CO2) within sea ice using observation data and a one-dimensional halo-thermodynamic sea ice model, including gas physics and biogeochemistry. The incorporation and transport of dissolved CO2 within sea ice, as well as its rejection via gas-enriched brine drainage to the ocean, are modeled following fluid transport equations through sea ice. Gas bubbles nucleate within sea ice when CO2 concentration is above saturation. These bubbles rise to the ice surface due to their own buoyancy when the brine network is connected. Different formulations are tested for the CO2 fluxes between sea ice and the atmosphere (including wind speed, the presence/absence of snow and the differential partial pressure of CO2 between sea ice brines and the atmosphere). The consumption and release of CO2 by primary production and respiration are modeled. Finally, the precipitation and dissolution of ikaite (CaCO3) which influences CO2 concentration within sea ice are modeled. A simulation corresponding to a case study covering the seasonal growth of first-year ice at Point Barrow, Alaska, was run. How specific gas processes affect CO2 dynamics within Arctic sea ice will be discussed

Modelling argon dynamics in first-year sea ice

Abstract: Focusing on physical processes, we aim at constraining the dynamics of argon (Ar), a biogeochemically inert gas, within first year sea ice, using observation data and a one-dimensional halo-thermodynamic sea ice model, including parameterization of gas physics. The incorporation and transport of dissolved Ar within sea ice and its rejection via gas-enriched brine drainage to the ocean, are modeled following fluid transport equations through sea ice. Gas bubbles nucleate within sea ice when Ar is above saturation and when the total partial pressure of all three major atmospheric gases (N2, O2 and Ar) is above the brine hydrostatic pressure. The uplift of gas bubbles due to buoyancy is allowed when the brine network is connected with a brine volume above a given threshold. Ice-atmosphere Ar fluxes are formulated as a diffusive process proportional to the differential partial pressure of Ar between brine inclusions and the atmosphere. Two simulations corresponding to two case studies that took place at Point Barrow (Alaska, 2009) and during an ice-tank experiment (INTERICE IV, Hamburg, Germany, 2009) are presented. Basal entrapment and vertical transport due to brine motion enable a qualitatively sound representation of the vertical profile of the total Ar (i.e. the Ar dissolved in brine inclusions and contained in gas bubbles; TAr). Sensitivity analyses suggest that gas bubble nucleation and rise are of most importance to describe gas dynamics within sea ice. Ice-atmosphere Ar fluxes and the associated parameters do not drastically change the simulated TAr. Ar dynamics are dominated by uptake, transport by brine dynamics and bubble nucleation in winter and early spring; and by an intense and rapid release of gas bubbles to the atmosphere in spring. Important physical processes driving gas dynamics in sea ice are identified, pointing to the need for further field and experimental studies.Bigsout

PERTINENCE PÉDAGOGIQUE DE LA SIMULATION CLINIQUE PAR RÉALITÉ VIRTUELLE DANS LA FORMATION COLLÉGIALE SOINS PRÉHOSPITALIERS D’URGENCE 181.A0

Research Issue: Recent public data indicates that college students of the Pre-Hospital Emergency Care 181.A0 Program lack exposure to authentic learning opportunities, which could reduce their ability to fully acquiring certain prescribed skills. In spite of the program’s excellent success rate, between 2014 and 2018, almost 41% of candidates to the paramedical profession failed the knowledge assessment required for entry into the Programme national d’intégration clinique (PNIC) on their first attempt. The PNIC is a training-assessment program that enables successful candidates to become practicing paramedics in Québec. One should note that the PNIC’s knowledge assessment is a high-stakes test that requires successful completion of two distinct isochron exams, one theoretical, the other, practical. Most PNIC test failures are caused by not passing the practical exam. This led us to think that the methods used to teach clinical protocols and interventions in the 181.A0 Program do not enable students to optimally meet the requirements of the PNIC practical exam. As a solution to this issue, the immersive use of clinical simulations in a virtual reality environment or VR-sim, based on authentic interventions that paramedics perform daily, represents an innovative educational method that allows students to contextualize the practical training received in the Pre-Hospital Emergency Care Program. There is reasonable ground to believe that this educational solution would contribute to optimizing the preparation of students wanting to become paramedics and help them meet the professional requirements of the PNIC practical exam. Objectives: This research had two fundamental objectives: 1) Conceptualize, create and test two virtual clinical simulation environments that would be used for the practical training of fifth-session Pre-Hospital Emergency Care students and the continuing professional development of paramedics. 2) Assess the perception that these fifth-session students and paramedics have of the efficiency of immersive clinical simulation in a virtual reality environment as a teaching method. Research Questions: In order to objectify the perception that students and paramedics have of the efficiency of immersive virtual clinical simulations (VR-sim) as a teaching method, this research had to answer the following four questions: 1) What perception do students and paramedics have of the educational design of VR-sim? 2) What perception do they have of good teaching practices related to VR-sim learning? 3) What level of satisfaction do they feel toward their VR-sim learning? 4) What level of confidence do they have in their VR-sim learning?Methodology: This exploratory and multicentric research is based on a mixed research methodology [i.e., an explanatory sequential mixed method design (QUAN → qual), based on quantative and qualitative data]. The data was gathered from a convenience sample of 35 subjects (20 fifth-semester students taking the 181-540-SF – Intégration 1 Course as part of the regular Pre-Hospital Emergency Care 181.A0 Program, and 15 practicing paramedics). The quantitative part of the research was based on a pre-experimental post-test protocole. The qualititative part was carried out by doing a thematic content analysis. Results: The quantitive results obtained from four measurement tools suggest that the research subjects liked the pedagogical design of the VR-sim, as well as the teaching methods that the facilitators used during the activity. Results also showed that the subjects were quite satisfied with what they had learned during the VR-sim activity and were confident that the new knowledge that they had acquired would help them solve paramedical issues. There was no statistical difference between the scores of the fifth-session students and those of the paramedics on the four measurements. Regarding the qualitative results, the thematic content analysis allowed us to identify seven (7) emerging themes: 1) Realism of the simulation environment and closeness to the task; 2) Realism of the clinical situation; 3) Adaptation period; 4) Opportunities for action and interaction; 5) Limitiations of the scenarios; 6) Decision-making; and finally 7) Teacher support. Conclusion: The results of this reseach are unequivocal and suggest that the authentic learning produced by immersive virtual clinical environments was appreciated by both student and paramedic subjects. All in all, there are reasons to believe that the knowledge and skills acquired in virtual clinical simulations will optimize the ability of students hoping to become paramedics to pass the knowledge assessment test required for entry into the Programme national d’intégration clinique.PERTINENCE PÉDAGOGIQUE DE LA SIMULATION CLINIQUE PAR RÉALITÉ VIRTUELLE DANS LA FORMATION COLLÉGIALE SOINS PRÉHOSPITALIERS D’URGENCE 181.A

The role of sea ice in the carbon cycle of Polar Seas: 1D to 3D modelling

Sea ice participates actively in the biogeochemical cycle of carbon of Polar Oceans, yet to which extent is not clear. We investigated the processes that govern sea ice carbon dy- namics in Polar Regions through 1D to 3D modelling developments. First, we constrained all major physical and biogeochemical processes with respect to CO2 dynamics (carbon- ate chemistry, biological activity, ikaite (CaCO3•6H2O) precipitation and dissolution and ocean-ice-air CO2 fluxes) in a one-dimensional sea ice model. According to our model, the CO2 budget is driven by the CO2 uptake during ice growth and release by brine drainage, whereas other processes such as brine-air CO2 fluxes, despite significant, are secondary. Subsequently, based on these preliminary conclusions, we evaluated the role of sea ice in the carbon dynamics of Polar Oceans by using an ocean-ice coupled Global Earth System Model. Carbon dynamics (e.g. ocean-atmosphere CO2 fluxes) are driven by the contribution of sea ice growth regions in the Arctic Ocean (mainly the Siberian coast) and sea ice melt regions in the Southern Ocean (off the coast of Antarctica). In addition, the production of deep waters is low in the Arctic Ocean but significant in the Southern Ocean. Therefore, sea ice only contributes to the deep water export of carbon in the Southern Ocean. The role of sea ice in the biogeochemical cycle of carbon is significant and its representation by Global Earth System Models should be improved