Acting on Reflection: the Effect of Reflection on Students’ Clinical Performance on a Standardized Patient Examination

BACKGROUND: Little evidence exists to support the value of reflection in the clinical setting. OBJECTIVE: To determine whether reflecting and revisiting the “patient” during a standardized patient (SP) examination improves junior medical students’ performance and to analyze students’ perceptions of its value. DESIGN: Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists. PARTICIPANTS: One hundred and forty-nine third year medical students. MEASUREMENTS: Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases. RESULTS: On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated “reflect–revisit” positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism. CONCLUSIONS: Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect–revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence

Pharmacist-only supply of nicotine vaping products: proposing an alternative regulatory model for Australia

Regulation of nicotine vaping products (NVPs) is an ongoing challenge across the world. Australia currently has a globally unique NVP regulatory model that requires a medical prescription to purchase and use NVPs, with further restrictions in progress in response to evidence of widespread illicit NVP sales. Against this background, we examine the new measures and consider a modification of the model to pharmacist-only supply as an option for increasing access to NVPs for smoking cessation, while retaining health practitioner oversight of supply. We describe the strengths and challenges of implementing a pharmacist-only NVP supply option in Australia. Compared with the current prescription-only model, pharmacist-only supply could increase access to a lower exposure nicotine product in a highly regulated therapeutic context while addressing youth access and purchasing for non-therapeutic use, reduce demand for illicit products for smoking cessation purposes and avoid overburdening medical services with consultations to obtain NVP prescriptions. This approach can also accommodate current government goals such as eliminating NVP advertising, youth-focused branding and supply from grocery and convenience stores.</p

A novel device for collecting and dispensing fingerstick blood for point of care testing

<div><p>The increased world-wide availability of point-of-care (POC) tests utilizing fingerstick blood has led to testing scenarios in which multiple separate fingersticks are performed during a single patient encounter, generating cumulative discomfort and reducing testing efficiency. We have developed a device capable of a) collection of up to 100 μL of fingerstick blood from a single fingerstick by capillary action, and b) dispensing this blood in variable increments set by the user. We tested the prototype device both in a controlled laboratory setting and in a fingerstick study involving naive device users, and found it to have accuracy and precision similar to a conventional pipettor. The users also found the device to be easy to use, and recommended minor ergonomic improvements. Our device would allow performance of multiple POC tests from a single fingerstick blood sample, thus providing a novel functionality that may be of use in many testing settings worldwide.</p></div

In-house gravimetric testing results for the POC Blood Dispenser by an experienced user compared to in-house gravimetric testing results for a P20 pipettor.

<p>In-house gravimetric testing results for the POC Blood Dispenser by an experienced user compared to in-house gravimetric testing results for a P20 pipettor.</p

The shuttle valve in each of its three positions.

<p>Left: shuttle valve position one; airflow between capillary and atmosphere, allowing capillary to be filled. Middle: shuttle valve position two; airflow between piston chamber and capillary, allowing blood to be dispensed. Right: shuttle valve position three; airflow between atmosphere and piston chamber, allowing the chamber to be primed for another dispense.</p

The volume adjustment mechanism.

<p>Left: dispensing 10 μL. Right: dispensing 25 μL.</p

Blood being collected from donor with POC Blood Dispenser during clinical testing.

<p>May 26, 2016. PATH, Seattle, WA.</p

Fingerstick blood testing results for the POC Blood Dispenser.

<p>Fingerstick blood testing results for the POC Blood Dispenser.</p

The Blood Collection Card (BCC), 7 x 10 cm.

<p>Left: BCC illustration. Right: completed BCC.</p