Curriculum Setting and Pre-Clinical Dental Students' Stress Level

Objectives: The first two years of Dental School are commonly known to be the most stressful in a student’s academic career. Very few studies, however, consider both the pressures of dental school and their causes. In order to understand the relationship between the curriculum and its stressful effects it has on the first (D1) and second-year (D2) dental students, a cross-sectional study was performed at the University of New England College of Dental Medicine (UNE-CDM) during the fall and spring semesters of the 2015-2016 academic year. Methods: 64 D1 and 63 D2 dental students were asked to voluntarily complete an anonymous 27-question survey regarding demographic characteristics and the curriculum-related stressors. Researchers utilized the modified Dental Environment Scale (DES) to rate the stress levels. Results: This study revealed that the D2 students felt more stress than the D1 students overall. D2 students experienced more anxiety in their Spring semester of their second year. In general, students who lived with their immediate family felt less stress. Students twenty-five and over experienced less stress than their younger classmates. Conclusions: The study provided valuable information about the current structure of the curriculum at a newly established dental school. This study could provide insight into curriculum-related stress among pre-clinical dental students, which could guide dental schools in making curricular changes that help alleviate stressors during particularly stressful semesters. Furthermore, the outcomes of this project could provide dental schools the information necessary to develop student support programs to help balance students’ lives and intense course loads

Development of a Certificate in Healthcare Improvement for Inter-Professional Teams

Introduction To address gaps in care team improvement-science education and connect geographically dispersed learners, we created a healthcare improvement certificate program, now completing the third program year, for inter-professional (IP) healthcare teams, including third year medical students. Methods This hybrid learning program consists of five modules: Learning Healthcare Systems, Improvement Science, Patient Safety and Diagnostic Error, Population Health and Health Equity and Leading Change. The curricular materials are comprised of focused readings, concise videos, faculty-moderated discussion boards, weekly synchronous calls of participants with faculty, and a longitudinal improvement project. The faculty are content experts, and worked with a curricular designer to define learning objectives and develop content. Results We have completed three years of this six-month program, training 61 participants (17 of whom were medical students) at 14 sites. In the third year, several medical students participated without an IP team. Development of the materials has been iterative, with feedback from learners and faculty used to shape the materials. Discussion We demonstrate the development and rollout of a hybrid-learning program for diverse and geographically dispersed IP teams, including medical students. Time restrictions limited the depth of topics, and scheduling overlap caused some participants to miss the interactive calls. We plan to evaluate the utility of the program for participants over time, using qualitative methods. Conclusion This educational model is feasible for IP teams studying improvement science and implementing change projects, and can be adopted to dispersed geographic settings

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society