Extracurricular work experience and its association with training and confidence in emergency medicine procedures among medical students: a cross-sectional study from a Norwegian medical school

Objective Proficiency in basic emergency procedures is important for junior doctors, but the amount of practical exposure may vary. We studied the association between students’ extracurricular healthcare-related (ECHR) work experience and self-reported practical training and confidence in selected emergency medicine procedures. Study design Cross-sectional study. Materials and methods Medical students and first-year graduates answered a Likert-based questionnaire probing self-reported amount of exposure to (‘training amount’) and confidence with selected emergency medicine procedures. Participants also reported ECHR work experience, year of study, previous healthcare-related education, military medic training and participation in the local student association for emergency medicine (Tromsø Acute Medicine Students’ Association (TAMS)). Differences within variables were analysed with independent samples t-tests, and correlation between training amount and confidence was calculated. Analysis of covariance and mixed models were applied to study associations between training amount and confidence, and work experience (primary outcomes) and the other reported factors (secondary outcomes), respectively. Results 539 participants responded (70%). Among these, 81% had ECHR work experience. There was a strong correlation (r=0.878) between training amount and confidence. Work experience accounted for 5.9% and 3.5% of the total variance in training amount and confidence (primary outcomes), and respondents with work experience scored significantly higher than respondents without work experience. Year of study, previous education, military medic training and TAMS participation accounted for 49.3%, 8.7%, 6.8% and 23.6%, and 58.5%, 5.1%, 4.7% and 12.3% of the total variance in training amount and confidence, respectively (secondary outcomes). Cohen’s D was 0.48 for training amount and 0.32 for confidence level, suggesting medium and weak medium-sized associations with work experience, respectively. Conclusion ECHR work experience is common among medical students and was associated with more training amount and higher confidence in the procedures. Year of study, previous relevant education and TAMS participation, but not military medic training, were also significantly associated with training amount and confidence

Barriers to body temperature monitoring among prehospital personnel: A qualitative study using the modified nominal group technique

Objectives - To identify and explore barriers that healthcare professionals working as prehospital care (PHC) providers at the University Hospital of North Norway experience with temperature monitoring and discover solutions to these problems. Study design - Qualitative study using the modified nominal group technique. Materials and methods - 14 experienced healthcare professionals working in air and ground emergency medical services were invited to the study. Initially, each participant was asked to suggest through email topics of importance regarding barriers to prehospital thermometry. Afterwards, they received a list of all disparate topics and were asked to individually rank them by importance. The top-ranked topics were discussed in a consensus meeting. The meeting was audio-recorded and a transcript was written and then analysed through an inductive thematic analysis. Results - 13 participants accepted the invitation. 63 suggestions were reduced to 24 disparate topics after removal of duplicates. Twelve highly ranked topics were discussed during the consensus meeting. Thematic analysis revealed 47 codes that were grouped together into six overarching themes, of which four described challenges to monitoring and two described potential solutions: equipment dissatisfaction, little focus on patient temperature, fear of iatrogenic complications, thermometry subordinated, more focus on temperature and simplification of thermometry. Conclusion - To increase the frequency of temperature measurement on correct indication, we suggest introducing PHC protocols that specify patients and conditions where an accurate temperature measurement should have high priority. Furthermore, there is a profound need for more suitable techniques for temperature monitoring in the prehospital setting

Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records

Background: The patient handover is important for the safe transition from the pre-hospital setting to secondary care. The loss of critical information about the pre-hospital phase may impact upon the clinical course of the patient. Methods: University Hospital Emergency Care registrars answered a questionnaire about how they perceive clinical documentation from the ambulance services. We also reviewed patient records retrospectively, to investigate to what extent eight selected parameters were transferred correctly to hospital records by clinicians. Only parameters outside the normal range were selected. Results: The registrars preferred a verbal handover with hand-written pre-hospital reports as the combined source of clinical information. Scanned report forms were infrequently used. Information from other doctors was perceived as more important than the information from ambulance crews. Less than half of the selected parameters in prehospital notes were transferred to hospital records, even for parameters regarded as important by the registrars. Abnormal vital signs were not transferred as often as mechanism of injury, medication administered and immobilisation of trauma patients. Conclusions: Data on pre-hospital abnormal vital signs are frequently not transferred to the hospital admission notes. This information loss may lead to suboptimal care

Medical school and self-reported practical skills: How do the UiT medical students acquire practical competence in emergency medicine skills?

Abstract Aims: To investigate how extracurricular healthcare-related (ECHR) work experience influenced University of Tromsø – The Arctic University of Norway’s medical students’ and graduates’ achieved level of practical training and their self-perceived confidence in selected practical skills believed to be important for emergency medicine. Materials and methods: Medical students and graduates answered a Likert-based questionnaire probing their amount of training within selected skills relevant for emergency medicine, as well as their self-perceived confidence with these skills. Work experience and other potential confounding factors were recorded as well. Cronbach’s alpha was calculated to test internal consistency. Descriptive statistics were conducted for data visualization, and analysis of covariance and linear mixed models were applied to adjust for confounder effects. Results: 70% of all invited participants answered the questionnaire, of which 81% had ECHR work experience. High Cronbach’s alpha was achieved for questions probing each of the two main outcomes (.927 and .919, respectively). A positive correlation between training amount and confidence level for all respondents was found, and participants with work experience scored significantly higher for both outcomes. Year of study and participation in Tromsø Acute Medicine Students’ Association (TAMS) affected the outcomes significantly more than the other confounders. Work experience accounted for 6.7% and 3.6% of the total variance in the two outcome variables respectively, adjusted for the potential confounders. Estimated marginal means showed that respondents with work experience yielded significantly higher scores than non-workers for both outcomes. Conclusion: Students and graduates with extracurricular healthcare-related work experience had more training and more self-perceived confidence in performing basic skills relevant for emergency medicine, compared to students without such experience. However, other factors such as year of study, previous education, military medic-training as well as TAMS participation had significant impact on how students scored themselves on amount of training and self-perceived confidence level. Keywords: Medical education, practical skills, emergency medicine, healthcare-related work experienc

Evaluation of a university hospital trauma team activation protocol

<p>Abstract</p> <p>Background</p> <p>Admission with a multidisciplinary trauma team may be vital for the severely injured patient, as this facilitates rapid diagnosis and treatment. On the other hand, patients with minor injuries do not need the trauma team for adequate care. Correct triage is important for optimal resource utilization. The aim of the study was to evaluate our criteria for activating the trauma team, and identify suboptimal criteria that might be changed in the interest of precision.</p> <p>Methods</p> <p>The study is an observational, retrospective cohort-study. All patients admitted with the trauma team (n = 382), all severely injured (Injury Severity Score (ISS) >15) (n = 161), and all undergoing an emergency procedure aimed at counteracting compromised airways, respiration or circulation at our hospital (n = 142) during 2006-2007 were included. Data were recorded from the admission records and the electronic patient records. The trauma team activation protocol was evaluated against the occurrence of severe injury and the occurrence of emergency procedures.</p> <p>Results</p> <p>A total of 441 patients were included. The overtriage was 71% and undertriage 32% when evaluating against ISS >15 as the standard of reference. When occurrence of emergency procedures was held as the standard of standard of reference, the over- and undertriage was 71% and 21%, respectively. Mechanism of injury-criteria for trauma team activation contributed the most to overtriage. The emergency procedures performed were mostly endotracheal intubation and external fixation of fractures. Less than 3% needed haemostatic laparotomy or thoracotomy. Approximately 2/3 of the overtriage represented isolated head or cervical spine injuries, and/or interhospital transfers.</p> <p>Conclusions</p> <p>The over- and undertriage of our protocol are both too high. To decrease overtriage we suggest omissions and modifications of some of the criteria. To decrease undertriage, transferred patients and patients with head injuries should be more thoroughly assessed against the trauma team activation criteria.</p

Benthic algal vegetation in Isfjorden, Svalbard

Benthic algal vegetation was investigated at 10 sites in Isfjorden, Svalbard. Five sites were visited during summer 2010 and five during summer 2012. Both the littoral and sublittoral vegetation were sampled, the littoral by hand-picking and use of a throwable rake and the sublittoral using a triangular dredge. A total of 88 different taxa were registered, comprising 17 Chlorophyta, 40 Ochrophyta, 30 Rhodophyta and the Xantophyceae Vaucheria sp. The green algae Ulvaria splendens (Ruprecht) Vinogradova was recorded in Svalbard for the first time. Most of the sites consisted of hard bottom substrate, but one site, Kapp Wijk, consisted of loose-lying calcareous red algae (rhodoliths) and had species not recorded elsewhere. The sublittoral at the other sites was dominated by kelp. Molecular analysis confirmed the presence of the red alga Ceramium virgatum and a dwarf form of the brown alga Fucus vesiculosus. This study provides a baseline for future studies investigating changes in the vegetation due to environmental changes

Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study

Background The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS. Methods Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran–Mantel–Haenszel methods and mixed-effects models. Results Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4–5.4). Conclusions Our results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients.publishedVersio

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study

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