Learning Gains Derived from a High-fidelity Mannequin-based Simulation in the Pediatric Emergency Department

There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 ± 15% to 93 ± 4%) and behaviors (from 65 ± 18% to 85 ± 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department

Predicting the demand of physician workforce: an international model based on "crowd behaviors"

<p>Abstract</p> <p>Background</p> <p>Appropriateness of physician workforce greatly influences the quality of healthcare. When facing the crisis of physician shortages, the correction of manpower always takes an extended time period, and both the public and health personnel suffer. To calculate an appropriate number of Physician Density (PD) for a specific country, this study was designed to create a PD prediction model, based on health-related data from many countries.</p> <p>Methods</p> <p>Twelve factors that could possibly impact physicians' demand were chosen, and data of these factors from 130 countries (by reviewing 195) were extracted. Multiple stepwise-linear regression was used to derive the PD prediction model, and a split-sample cross-validation procedure was performed to evaluate the generalizability of the results.</p> <p>Results</p> <p>Using data from 130 countries, with the consideration of the correlation between variables, and preventing multi-collinearity, seven out of the 12 predictor variables were selected for entry into the stepwise regression procedure. The final model was: PD = (5.014 - 0.128 × proportion under age 15 years + 0.034 × life expectancy)², with R²of 80.4%. Using the prediction equation, 70 countries had PDs with "negative discrepancy", while 58 had PDs with "positive discrepancy".</p> <p>Conclusion</p> <p>This study provided a regression-based PD model to calculate a "norm" number of PD for a specific country. A large PD discrepancy in a country indicates the needs to examine physician's workloads and their well-being, the effectiveness/efficiency of medical care, the promotion of population health and the team resource management.</p

Pediatric residents' learning gains derived from a high fidelity child mannequin used to simulate critical cases in emergency room

Bibliography: p. 82-85

The Use of Medical Cognition in Medical Curriculum Reform in Taiwan

Medical cognition studies have generated a great deal of knowledge that can be used to improve the quality of medical education. This review summarizes medical cognition research, the trends in medical education, and how the results of cognitive research can be applied to medical curriculum reform in Taiwan. The current trend in medical education is to develop a student-centered, outcome-oriented curriculum that integrates basic and clinical science, introduces students to patients at an early stage, reduces redundancy, and promotes active learning. To help students to develop and maintain their expertise in medicine, extensive supervised training with evaluation and feedback should be provided. The curriculum should also be designed to provide a learning context in which students are helped to develop a knowledge structure and diagnostic strategies similar to those used by experts. Finally, the curriculum should be flexible and responsive to the needs of students to train them to be excellent physicians in the future

Learning Gains Derived from a High-fidelity Mannequin-based Simulation in the Pediatric Emergency Department

There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 ± 15% to 93 ± 4%) and behaviors (from 65 ± 18% to 85 ± 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department

A comparison of Canadian and Taiwanese physician ehtical reasoning using clinical vingettes

Bibliography: p. 213-23

Career Satisfaction, Commitment, and Well-being Among Taiwanese Pediatricians

Currently, the pediatrician shortage in Taiwan has raised concerns about pediatricians' workloads and wellbeing. This study aimed to understand in-hospital pediatricians' perceptions toward career satisfaction and their wellbeing. Methods: A questionnaire exploring pediatricians' life management, commitment to work, and work satisfaction was distributed to all the pediatricians (including attending physicians and residents) in 79 certified training institutions in Taiwan. After expert validation and pilot testing, 17 items with a five-point rating scale were developed to reflect the pediatricians' perceptions. There were 287 responses in total, including 180 attending physicians and 107 residents. Factor analysis was used to explore the construct structure underlying the 17 items. Results: None of the 17 items had a “positive” mean score (≥4/5). Using factor analyses, five factors were extracted: commitment to medical career, self-care, benefit, work environment, and job satisfaction, which accounted for 66.97% of the variance. The factor with the lowest scores was self-care, followed by benefit. The mean score of factors ranged from 2.91 ± 0.17 to 1.64 ± 0.1, all considered “negative.” Only 33.6% indicated satisfaction with their jobs. Only 60% of the pediatricians liked their medical career and work environment. The reliability alphas of the five factors ranged from 0.85 to 0.60. Conclusion: Currently, Taiwanese pediatricians are not satisfied with their jobs, having low commitment, poor self-care, and little wellbeing. This study provides a possible explanation for why young physicians leave the pediatric sector, and it also reveals the consequences of physician shortage in Taiwan

Hospital-based school for children with chronic illness in Taiwan

To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. Methods: The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. Results: Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. Conclusion: The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children

Analyzing the effectiveness of teaching and factors in clinical decision-making

Objective: The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an “Analogy guide clinical decision-making” as a learning intervention for junior doctors. Materials and Methods: This study had a “quasi-experimental design” and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the “Analogy guide for teaching clinical decision-making” every day for 3 months. Program Evaluation: A “Clinical decision-making self-evaluation form” was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. Results: We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. Conclusion: Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making