“Making a list and checking it twice”

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83758/1/876_ftp.pd

Are we providing patient-centered care? Preferences about paracentesis and thoracentesis procedures

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for procedure location. Two hundred and twenty surveys (162 paracentesis and 58 thoracentesis) were completed on 152 patients. Patient satisfaction was similar for bedside and IR procedures across all domains. A location preference was expressed in 151 surveys (68.6%). Thirty-five of 108 responses (32.4%) from patients with a paracentesis expressed a preference for bedside procedures while 73/108 (67.6%) responses expressed a preference for IR. Twenty-eight of 43 responses (65.1%) from patients with a thoracentesis expressed a preference for bedside procedures while 15/43 (34.9%) responses expressed a preference for IR. Comfort was listed as the most common reason for preferring the bedside while specialized equipment and safety were the most common reasons for preferring IR. Patients are equally and highly satisfied with bedside and IR paracentesis and thoracentesis procedures. Because both approaches are safe and effective, clinicians should pursue informed discussions with patients when a choice is available

Does Simulation-based Medical Education with Deliberate Practice Yield Better Results than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence

PURPOSE: This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). METHOD: This is a quantitative meta-analysis that spans twenty years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes. RESULTS: Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared to traditional clinical medical education was 0.71 (95% confidence interval, 0.65–0.76; P < .001). CONCLUSIONS: Although the number of reports analyzed in this meta analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness

Use of Simulation-Based Mastery Learning Curriculum to Improve Difficult Conversation Skills Among Anesthesiologists: A Pilot Study

BACKGROUND: Breaking bad news (BBN) is an important clinical task for physicians. Unfortunately, there is no standard method to teach and assess these skills of anesthesiologists. Although anesthesiology has become a relatively safe medical specialty, complications still occur that require disclosure to patients and their families. Disclosure of bad news can be a significant source of stress for clinicians, especially for those who have low confidence in their BBN skills. Anesthesiologists\u27 skills in BBN can be improved with simulation-based mastery learning (SBML), an intense form of competency-based learning. METHODS: An SBML curriculum was developed using the SPIKES (Situation, Perception, Invitation, Knowledge, Emotion, Summarize) framework for BBN and the NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for expressing empathy. A pretest-posttest study was conducted from March 2020 to June 2022 to evaluate anesthesiologists\u27 performance in BBN. Participants completed a 2-hour curriculum consisting of a pretest, didactic session, deliberate practice with feedback, and a posttest. Anesthesiologists were assessed using a 16-item skills checklist. RESULTS: Six anesthesiology attendings and 14 anesthesiology fellows were enrolled in the study. Three of 20 participants met the minimum passing score (MPS) at the time of their pretest. All study participants met the MPS on their first posttest (P \u3c .001). The median participant confidence in BBN significantly increased (3 to 4, P \u3c .001). Overall course satisfaction in the curriculum was high, with a median score of 5. CONCLUSIONS: Our study demonstrates that a BBN SBML curriculum for anesthesiologists significantly improved communication skills and confidence in a simulated environment. Because only 3 participants met the MPS before training, our results suggest that anesthesiologists could benefit from further education to gain effective communication skills and that SBML training may be effective to achieve this result

Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice

Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team’s voice and safety are important. Calls for personal, physical or patient safety should never be disregarded or met with retaliation

Use of a National Continuing Medical Education Meeting to Provide Simulation-Based Training in Temporary Hemodialysis Catheter Insertion Skills: A Pre-Test Post-Test Study

Background: Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Objectives: Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Design: Pre-test – post-test study. Setting: 2014 Canadian Society of Nephrology annual meeting. Participants: Nephrology fellows, internal medicine residents and medical students. Measurements: Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Methods: Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Results: Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Limitations: Small sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference. Conclusions: Despite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate