The Effect of Language Barrier and Non-professional Interpreters on the Accuracy of Patient-physician Communication in Emergency department

Introduction: Patients’ relatives commonly play the role of interpreters in medical interviews. These non-professional interpreters are prone to potentially-dangerous translation errors. Objective: The present study was conducted to evaluate these errors in the emergency department (ED). Method: Twenty interviews with Azeri patients were recorded. They were unable of speaking Persian and therefore accompanied by a relative as a Persian interpreter. These records were presented to two physicians as native Azeri speakers to determine the clinical importance of the interpreters' errors according to their medical expertise. Results: The total omission and addition errors observed in Azeri to Persian translation were significantly more than in Persian to Azeri translation, while mistranslation errors were almost the same. The relatives with higher levels of education made fewer errors, and those living with the patients made significantly more addition errors. Conclusion: Non-professional interpreters cannot effectively facilitate patient-physician communication, as their translation is error-prone, especially in terms of translating their native language into official languages. These errors can have important clinical ramifications

Effect of repetitive feedbackon residents' communication skills improvement

Peer reviewedPublisher PD

A 24-year-old Female Traumatic Patient Following a Car Accident

A healthy 24-year-old female presented at the emergency department (ED) after a car accident with ambulance while injured severely after the bus got run over her lower limb. As the trauma team was activated, her primary survey was started: Ac (Airway and cervical collar): She was awake and could talk. Cervical collar was fixed, oxygenation with face mask was started. B (Breathing): Her chest rising was symmetrical without any laceration or abrasion. Chest auscultation was clear and there was no tenderness or crepitation on palpation. No tracheal shift was found. She had normal respiratory rate and O2 saturation of 94% at ambient air. C (Circulation): Two large bore IV lines were inserted and blood samples were obtained. Her vital signs were BP = 60/40 mmHg, PR = 130/min, RR = 12. E-FAST was performed which was negative for free fluid in abdomen, pelvis and thorax, tamponade, and hemopneumothorax. Her pelvis was unstable on examination and pelvic wrapping was performed with sheath. IV fluid therapy with normal saline was started followed by 3 units of packed RBC transfusion. More pack cells and FFP were also requested. D (Disability): She had Glasgow coma scale of 15/15 with normal size and reactive pupil. No neurologic deficit was found except disability of lower extremities due to crush injury. E (Exposure): She had no midline spinal tenderness with normal sphincter anal tone, but there was a laceration in the perineum which extended to the vagina. Portable chest and pelvic x-ray as an adjutant to primary survey were performed which showed type C pelvic fracture. On her secondary survey, she had abrasion on her scalp, 1.5 cm laceration on her right tibia, deformity of her right thigh, and laceration in her genitalia with some vaginal bleeding. Direct pressure was applied and all lacerations were packed. According to negative e-FAST and pelvic fracture and shock, since the angiography was not available, it was decided to fix the pelvis with external fixator in the operation room. After the fixation, and because shock persisted, operative pelvic packing was undertaken. Unfortunately, she suffered cardiorespiratory arrest in the operating room and died

How long it takes patients\\\' initial statements of concerns? brief report

Background: There is a concern by some doctors that not interrupting the patients' initial statements of concerns can lead to too long medical visits. Therefore, in this study, the duration of the patients' initial statements of concerns was studied. Methods: This descriptive cross sectional study was conducted from August to October, 2011 in the Emergency Department of Imam Khomeini Hospital in Tehran. 100 patients entered the study through convenience sampling. Based on a 5 level triage system Emergency Severity Index (ESI), patients who were not life-threatening conditions (level 5) entered the study and critically ill patients and foreign patients were excluded from the study. Demographic data of the patients and durations the patients' initial statements of concerns were recorded and measured. Results: Fifty-six percent of patients were men. 79 percent of them had academic degree less than diploma and most of them have Persian ethnicity (60 percent). The mean age of the participants was 37.09 (SD, 1.68). The mean durations of patients' initial statements was 71.60±2.37 seconds. The minimum time was 22.51 seconds and the maximum time was 206.51 seconds. There was significant difference between age (P=0.001, r=0.382) and gender (P=0.032, df=98, t= -2.17) with the durations of patients' initial statements. But education level (P=0.996, F (2, 97)=0.004) and ethnicity (P=0.266, F (6, 93)=1.3) did not have a significant effect on the durations of patients' initial statements. Conclusion: According to the findings of this study, duration of patients' initial statements of concerns is less than what which leads to an increase the time of medical visits

Setting Standard Threshold Scores for an Objective Structured Clinical Examination using Angoff Method and Assessing the Impact of Reality Chacking and Discussion on Actual Scores

Introduction: A variety of standard setting methods are used worldwide for medical examination acceptance scores while standards of most exams in our country are pre-determined fixed scores which are set without any scientific methodolgy. The aim of this study is to determine minimum pass level for a pre-internship objective structured clinical examination using Angoff method in Tehran University of Medical Sciences. Methods: After designing the questions for examination, a panel of eleven faculty members was formed. These judges were asked to individually estimate the probability that a borderline student would pass each station. The mean of all stations estimated by judges was considered as the standard for the whole exam. This procedure was repeated twice more after sessions of discussion between judges and checking students’ real scores. Results: The individual standard for the whole test was 49.15 while it turned to 49.90 after discussion and finally 51.52 after checking the real scores of students. The change of standard of the whole test after checking real scores was significant compared to individual standard (p=0.02). It showed no significant difference compared to the second standard. The rates of passing students according to the three standards were respectively 67.6%, 64.8% and 58.1% which showed a significant reduction in the third compared to the first one. Conclusion: Angoff method was used in this study to set standard for an OSCE. According to the findings of the study, it seems to be a credible and reliable procedure, especially when group discussion and reality check are used

Determining the contradictions of components of Calgary-Cambridge physician-patient communication skills with the attitude of Iranian patients

Aims: The absence of an appropriate relationship between the patient and the medical staff can lead to verbal and physical arguments and, therefore, lead to intervention from the police and filing a complaint and consequent legal problems. In Iran, patient communication skills are taught to medical students based on the Calgary-Cambridge observational model. As the Iranian society has social, cultural, and belief differences, the present study was designed and performed with the aim of determining the contradictions of the components of this model with the attitude of Iranian patients. Materials and methods: The present cross-sectional study was performed in Imam Khomeini Hospital, Tehran, Iran, in 2016. The sample consisted of conscious patients admitted to the emergency department. A researcher-made questionnaire was used to evaluate patients’ attitudes towards communication skills components based on the Calgary-Cambridge model. The questionnaire consisted of 33 questions regarding various communication skills components, and its reliability and validity were confirmed before being used in this study. Results: Overall, 100 patients with the mean age of 43.1 ± 16.7 years participated in the study, 51% of whom were male. The attitude of patients was contradictory to the guideline in some cases. There was more agreement with shaking hands with the physician among those residing in villages (p = 0.01); men more frequently agreed with being called by their name (p = 0.03), but women preferred to be called “madam” without a name or family name (p = 0.04); 68% of the patients preferred to sit across the physician during the visit; only 31% of the patients believed that the physician should ask for permission before the examination; only 31% of the patients agreed that a physician could look at a patient from the opposite sex. In other items, no significant difference was observed. Conclusion: The attitude of patients participating in the present study was contradictory to the mentioned guideline in some cases. Therefore, it would be better to revise the present model of teaching Calgary-Cambridge communication skills for the physician-patient relationship in some categories according to the culture of the Iranian society

Attitudes toward learning communication skills among Iranian medical students

Abstract Background Attitudes determine behavior, and alterations in attitude may result in behavioral changes. Medical students would benefit from learning communication skills. This study aimed to determine the attitude of medical students toward the importance of learning communication skills and the training courses and their role in contributing. Methods In this cross-sectional study, 442 medical students from three different levels of medical training were enrolled. Students in the first 4 years of the medical program were classified as basic sciences and physiopathology students, those in the fifth and sixth years were classified as clerkship students, and those in the last three terms of medical training were classified as interns. The attitude among these three groups was assessed by the Communication Skills Attitude Scale (CSAS) questionnaire, and the contributing factors were determined. Results The mean total points for attitude in positive and negative aspects were 50.7 and 30.9, respectively showing a positive attitude toward communication skills among medical students. The median scores of the scales Important in Medical Content, Excuse, Learning, and Overconfidence varied significantly from highest to lowest, respectively. Gender, educational level, ethnic origin, language, family burden, paternal literacy, history of presence in communication skills courses, self-report from communication skills, and need to further learning in this era showed significant association with attitude (P < 0.05). Conclusions It may be concluded that generally, medical students have a positive attitude toward communication skills, and this perspective is a multi-factorial entity that programming according to the various related factors would help to attainment of additional communication capabilities among medical students

Curriculum gaps in teaching clinical skills to Iranian undergraduate medical students

Introduction: The inefficacy of clinical skill education during the clerkship has been reported in several studies. The present study was conducted to evaluate the competency of medical students in performing several clinical skills through an Objective Structured Clinical Examination (OSCE), aiming to evaluate the quality of the existing curriculum in the clerkship phase. Material and methods: The cross sectional study was conducted at the end of the clerkship period, before the students had entered the internship. The OSCE exam was conducted in the morning (2 different tracts) and in the evening (2 similar tracts) and 86 students participated in the exam. Each tract consisted of seven stations. The students' points in the stations assessing history taking and clinical skills were compared. Results: The students gained the highest points in the history taking stations, whereas the procedure stations accounted for the lowest points; there was a significant difference between these stations (p < 0.001). The female students achieved higher scores in the OSCE exam compared to males (p = 0.004). Conclusions: The OSCE exam revealed the inefficacy of the current medical curriculum in teaching the required clinical skill to undergraduate medical students during the clerkship

Defining a Competency Framework: The First Step Toward Competency-Based Medical Education

Despite the existence of a large variety of competency frameworks for medical graduates, there is no agreement on a single set of outcomes. Different countries have attempted to define their own set of competencies to respond to their local situations. This article reports the process of developing medical graduates' competency framework as the first step in the curriculum reform in Tehran University of Medical Sciences (TUMS). A participatory approach was applied to develop a competency framework in Tehran University of Medical Sciences (TUMS). Following literature review, nominal group meetings with students and faculty members were held to generate the initial list of expectations, and 9 domains was proposed. Then, domains were reviewed, and one of the domains was removed. The competency framework was sent to Curriculum Reform Committee for consideration and approval, where it was decided to distribute electronic and paper forms among all faculty members and ask them for their comments. Following incorporating some of the modifications, the document was approved by the committee. The TUMS competency framework consists of 8 domains: Clinical skills; Communication skills; Patient management; Health promotion and disease prevention; Personal development; Professionalism, medical ethics and law; Decision making, reasoning and problem-solving; and Health system and the corresponding role of physicians. Development of a competency framework through a participatory approach was the first step towards curriculum reform in TUMS, aligned with local needs and conditions. The lessons learned through the process may be useful for similar projects in the future

Implementation a Medical Simulation Curriculum in Emergency Medicine Residency Program

Applying simulation in medical education is becoming more and more popular. The use of simulation in medical training has led to effective learning and safer care for patients. Nowadays educators have confronted with the challenge of respecting patient safety or bedside teaching. There is widespread evidence, supported by robust research, systematic reviews and meta-analysis, on how much effective simulation is. Simulation supports the acquisition of procedural, technical and non-technical skills through repetitive practice with feedbacks. Our plan was to induct simulation in emergency medicine residency program in order to ameliorate our defects in clinical bedside training. Our residents believed that simulation could be effective in their real medical practice. They mentioned that facilitators’ expertise and good medical knowledge, was the strongest point of the program and lack of proper facilities was the weakest