Improving Medical School Education on the Care of Sexual Assault Patients: A Quasi-Randomized Controlled Study

Introduction: Comprehensive healthcare for survivors of sexual violence is essential to prevent the diverse sequelae associated with the assault. In partnership with a local rape crisis center, we designed an educational module with the goal of training medical students on the basic needs of sexual assault patients with the aim to see if there was a significant difference in preparedness to counsel such patients. Methods: This quantitative quasi-randomized controlled study tested the effectiveness of an educational module on improving medical student preparedness for encounters with victims of sexual assault. A one-hour presentation, focusing on basic medical and legal knowledge regarding sexual abuse and compassionate patient-centered care, was provided to the intervention group during their compulsory Year 4 Emergency Medicine clerkship orientation. At the end of the month, students in the intervention and control groups were assessed using a standardized patient encounter simulating the presentation of a victim of sexual assault. Scores were determined by standardized patients, who utilized two checklists-one widely used for communication skills (KEECC-A) and the other focusing on sexual assault (WC-SAFE-specific). Results: For the KEECC-A, there was no significant difference in scores between the control and intervention groups (p=0.9257, 95% Confidence Interval [95%CI] 14.42,15.58]). The WC-SAFE-specific checklists were significantly different between the intervention and control groups (p=0.0076, 95%CI 3.79,4.21).  Conclusion: Our sexual assault module increased preparedness of medical students for encounters with sexual assault victims and provide trauma-informed care

Remdesivir for the Treatment of COVID-19: A Systematic Review of the Literature

In March 2020, the World Health Organization declared the spread of SARS-CoV-2 a global pandemic. To date, coronavirus disease-2019 (COVID-19) has spread to over 200 countries, leading to over 1.6 million cases and over 99,000 deaths. Given that there is neither a vaccine nor proven treatment for COVID-19, there is currently an urgent need for effective pharmacotherapy. To address the need for an effective treatment of SARS-CoV-2 during the worldwide pandemic, this systematic review of intravenous (IV) remdesivir was performed. Remdesivir, an anti-viral prodrug originally developed to treat Ebola virus disease, has shown broad spectrum activity against the Coronavirus family. A recent case report reported improvement of clinical symptoms with remdesivir in a patient with COVID-19. After conducting a systematic search of 18 clinical trial registries and three large scientific databases, we identified 86 potentially eligible items. Following removal of duplicates (n = 21), eligible studies were reviewed independently by two authors. After the first round of screening, inter-rater agreement was 98.5% (κ = 0.925). After the second round of full-text screening, inter-rater agreement was 100%. A total of seven ongoing and recruiting clinical trials of remdesivir (100-200 milligrams, intravenous [IV]) were included. We identified the following primary outcomes: patients discharged (n = 2); time to clinical status improvement (n = 2); improved O2 saturation (n = 2); body temperature normalization (n = 2); and clinical status (n = 1). Secondary outcomes in all identified studies included documentation of adverse events. Phase 3 trials are expected to be completed between April 2020–2023. Therefore, despite supportive data from in vitro and in vivo studies, the clinical effectiveness of IV remdesivir for treatment of COVID-19 and potential side effects remain incompletely defined in the human population

Medical Students Using Cadavers for Procedural Simulation Education

Background: Cadaver dissection remains integrated into the curriculum of numerous medical schools. Aspiring physicians acquire the opportunity to work directly with the human body, which is intricate and tangible, yet have minimal exposure to certain procedural skills applicable­­ to patient care during the first year of their medical training. Our aim was to incorporate the cadaver as part of a process to introduce procedures to a class of first year medical students in order to improve their confidence and skill in performing these procedures in patients. Methods: During medical gross anatomy at Wayne State University School of Medicine, three workshops involving common procedures performed in the emergency department were integrated into the cadaver dissection laboratory. Each educational workshop began with a short demonstration or a short step-by-step informational video on the focused procedure. The educators consisted of emergency medicine residents, third and fourth year medical student mentors, and emergency medicine attendings. Educators directed the hands-on procedure practice on the cadavers and provided real time feedback. Students completed pre and post questionnaires with scales ranging from one to five to assess the impact of the workshop on their abilities and confidence for the specified procedures. The three sessions included intraosseous (IO) line placement, joint aspiration, and chest tube placement. Results: A total of 108 students participated in the IO line training workshop, 143 students in the arthrocentesis simulation and 79 students in the chest tube session. Prior to the hands on sessions, 0 students (0%) had performed an IO line on a simulated patient, 2 students (1.4%) had performed an arthrocentesis on a simulated patient, and 4 students (5.1%) had performed a chest tube on a simulated patient. The Likert scales were viewed as ordinal variables (categorical variables) and thus the data was analyzed by Wilcoxon signed-rank test (non-parametric paired t-test). The student’s confidence in performing the specified procedure improved with a statistically significant difference in the IO, arthrocentesis and chest tube workshops (p = \u3c0.0001). There was a statistically significant increase in the perception of adequate training in all three sessions (p = \u3c 0.0001). The self-perceived skill in performing the described procedures had a statistically significant improvement for post training session in students participating in the IO, arthrocentesis and chest tube workshops (p = \u3c 0.0001). Lastly, after the hands-on educational sessions, a median of 4.5 out of 5 and mode of 5 out of 5 recommended other medical students participate in the IO simulation activity, and a median and mode of 5 out of 5 recommended the arthrocentesis and chest tube workshops. Conclusion: Workshops introducing procedural simulation in the cadaver to first year medical students improved confidence levels, perception of being adequately trained, and self-evaluated skill. Cadavers are effective models for training medical students in common emergency medical procedures. Integrating workshops into existing medical gross anatomy courses may translate into higher procedural success rates in the clinical setting, as well as stimulate interest in understanding normal anatomy and common variants encountered in practice

A novel simulation model for tube thoracostomy

Objective: Tube thoracostomy is a life-saving procedure that must be performed competently and expeditiously by emergency care providers. The primary objective of this project was to develop a simple, easily-reproducible, and realistic simulation model for tube thoracostomy placement by learners of emergency medicine. Methods: This chest tube simulator utilizes two slabs of pork ribs with associated intercostal muscle and fascial planes to aid learners in identifying anatomic landmarks, palpating intercostal spaces, and performing blunt dissection in a manner that approximates human anatomy. Holes are cut on both sides of a 1.8-bushel capacity rectangular plastic clothing hamper, and rib slabs are secured to the hamper with zip ties or metal wire. A bed pillow with plastic cover is then placed inside of the plastic hamper to simulate lung tissue. The rib-hamper complex is then wrapped with cellophane or elastic compression bandages to further anchor the rib slabs and simulate skin and subcutaneous tissues. Results: The initial cost of our thoracostomy model is approximately $50, much less than the$1,000–$3,000 cost for a commercial model. Although the hamper and pillow can be reused an indefinite number of times, the other components of our model must be replaced occasionally. Assuming a lifespan of 1,000 uses, our model costs approximately$1.78 per attempt, compared to $4.00 per attempt with the cheapest commercial mannequin system. In fact, assuming a longer useful lifespan for the mannequin does not substantially improve this comparison (e.g.$3.10 versus $1.77 per attempt for a 10,000 attempt lifespan for the commercial mannequin), largely due to the higher cost of commercial replacement skin pads when compared to the components consumed in our model with each attempt. Conclusions: We describe a porcine thoracostomy model that simulates the look and feel of human ribs for purposes of tube thoracostomy training, although it could also be used for thoracentesis and thoracotomy simulation. This model is relatively cheap (costing around$50) and easy to produce within a few minutes utilizing commonly-available materials. Further study is needed to determine whether an inexpensive model like ours provides the same educational value as more expensive commercial mannequin models