Effectiveness of Flexible Bronchoscopy Simulation-Based Training:A Systematic Review

Background: The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. Research Question: How effective is FB SBT and which instructional features contribute to training effectiveness? Study Design and Methods: We searched Embase, PubMed, Scopus, and Web of Science for articles on FB SBT for novice trainees, considering all available literature until November 10, 2022. We assessed methodological quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, evaluated risk of bias with relevant tools depending on study design, assessed instructional features, and intended to correlate instructional features to outcome measures. Results: We identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. All of the simulation training programs in studies with the highest methodological quality and most relevant outcome measures included curriculum integration and a range in task difficulty. Interpretation: Although most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting. Trial Registration: PROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/</p

Cognition, emotional state, and quality of life of survivors after cardiac arrest with rhythmic and periodic EEG patterns

Aim: Rhythmic and periodic patterns (RPPs) on the electroencephalogram (EEG) in comatose patients after cardiac arrest have been associated with high case fatality rates. A good neurological outcome according to the Cerebral Performance Categories (CPC) has been reported in up to 10% of cases. Data on cognitive, emotional, and quality of life outcomes are lacking. We aimed to provide insight into these outcomes at one-year follow-up. Methods: We assessed outcome of surviving comatose patients after cardiac arrest with RPPs included in the ‘treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation’ (TELSTAR) trial at one-year follow-up, including the CPC for functional neurological outcome, a cognitive assessment, the hospital anxiety and depression scale (HADS) for emotional outcomes, and the 36-item short-form health survey (SF-36) for quality of life. Cognitive impairment was defined as a score of more than 1.5 SD below the mean on = 2 (sub)tests within a cognitive domain. Results: Fourteen patients were included (median age 58 years, 21% female), of whom 13 had a cognitive impairment. Eleven of 14 were impaired in memory, 9/14 in executive functioning, and 7/14 in attention. The median scores on the HADS and SF-36 were all worse than expected. Based on the CPC alone, 8/14 had a good outcome (CPC 1–2). Conclusion: Nearly all cardiac arrest survivors with RPPs during the comatose state have cognitive impairments at one-year follow-up. The incidence of anxiety and depression symptoms seem relatively high and quality of life relatively poor, despite ‘good’ outcomes according to the CPC

Teaching Clinical Reasoning: An Experiment Comparing the Effects of Small-group Hypothetico-deduction Versus Self-explanation

Introduction: Research on the effectiveness of approaches for the teaching of clinical reasoning is scarce. A recent study showed hypothetico-deduction to be slightly more beneficial than self-explanation for students’ diagnostic performance. An account for this difference was unclear. This study investigated whether hypothetico-deduction leads to consideration of more alternative diagnoses while practicing with cases, and whether its advantage over self-explanation remains when diseases slightly different from the ones previously studied are tested. Methods: One-hundred thirty-nine 2nd-year students from a six-year medical school participated in a two-phase experiment. In the learning phase, they worked in small groups on five clinical vignettes of cardiovascular diseases by following different approaches depending on their experimental condition. Students under the self-explanation condition provided the most likely diagnosis and pathophysiological explanation for the clinical findings. Students under the hypothetico-deduction condition hypothesized about plausible diagnoses for clinical findings presented sequentially. In a one-week-later test, all students diagnosed eight cases of cardiovascular diseases with clinical presentations similar to the ones previously studied but different diagnoses. Results: The hypothetico-deduction condition generated more alternative diagnoses in the learning phase than the selfexplanation condition, F(1,177) = 199.51, p =.001, η2 = 0.53; the effect size was large. A small difference in favour of hypothetico-deduction was observed in the proportion of accurate diagnoses: F(1,138) = 4.08, p =.05, η2 = 0.03. Discussion: Relative to self-explanation, hypothetico-deduction induced consideration of more alternative diagnoses during practice with cases

Failure of faculty to fail failing medical students: Fiction or an actual erosion of professional standards?

الملخص: أهداف البحث: لقد أظهرت الدراسات المنشورة أن بعض المقيِّمين يضعون درجات نجاح لطلاب طب ما كان ينبغي لهم في حقيقة الأمر أن ينجحوا. فشل أعضاء هيئة التدريس هذا في ترسيب الطلاب ضعاف الأداء من الممكن أن يسيء إلى سمعة البرامج المهنية، سواء كان في الحقل الطبي أو خارجه. في الوقت نفسه، يصبح الطلاب الضعفاء أطباء غير أكفاء وبالتالي يعرِّضون المجتمع الذي يخدمونه للخطر. كان الدافع وراء إجراء هذه المراجعة المنهجية هو تحديد العوائق التي تمنع أعضاء هيئة التدريس من ترسيب طلاب الطب المتعثرين. طرق البحث: تم البحث في قواعد بيانات مدلاين، وسكوبس، ومكتبة وايلي على الإنترنت، ومكتبة كوكرين، وأوفد، وتَيلر وفرانسس، وسِنال، ورابط سبرنجر، وبروكويست وشبكة أي اس أي للمعرفة، تم البحث فيها باستخدام عناوين الموضوعات الطبية (مصطلحات ''مش”) التالية: ''ترسيب عضو هيئة التدريس '' و'' ترسيب الطلاب'' و''العجز عن الترسيب'' أو ''التقييم''. تم تنسيق البيانات وتحليل النتائج. النتائج: أظهر هذا البحث وجود وفرة من الحواجز لدى أعضاء هيئة التدريس تساهم في منعهم من الترسيب، مثل مخاوف أعضاء هيئة التدريس من الإجراءات القانونية، وعمليات الطعن، والتوتر من ترسيب الطلاب، ونقص المعرفة بالتوثيق المناسب، وعدم توافر مكاتب الدعم والموارد لأعضاء هيئة التدريس، وغياب التوجيهات الإدارية، وإجراءات الفصل المعقدة، التي تثني عضو هيئة التدريس عن ترسيب الطلاب. الاستنتاجات: ينبغي على برامج تطوير أعضاء الهيئة التدريسية في المؤسسة والورش التدريبية أن تيسر تعليم المشرفين والمقيِّمين على التقييم المتكرر والتوثيق المنتظم لتقييم المتدرب. كما نؤكد على ضرورة توفير المشورة القانونية في حالة الطعن ودعم ذوي الاختصاص من قبل مكتب الموارد والدعم. Abstract: Objectives: Literature has shown that some assessors assign passing grades to medical students who, in fact, should not have passed. This inability of the faculty to fail underperforming students can jeopardise the reputation of professional programs, be it in the medical field or beyond. Simultaneously, weak students become incompetent physicians and, thus, endanger the community they serve. The impetus for conducting this systematic review was to identify barriers to faculty in failing struggling medical students. Methods: The databases of MEDLINE, Scopus, Wiley online library, Cochrane library, OVID, Taylor and Francis, CINAHL, Springer link, ProQuest, and ISI Web of knowledge were searched using Medical Subject Headings (MeSH) terms ‘Faculty failure’ AND ‘Failing students’ AND ‘Failure to fail’ OR ‘Assessment’. The data were synthesised, and the results were analysed. Results: This search showed a wealth of barriers to faculty contributing to a ‘failure to fail’ such as their concerns about legal action and an appeals process; the stress of failing students; a lack of knowledge about proper documentation; unavailability of support, resources, and offices for faculty; absence of administrative guidelines; and complex dismissal procedures discouraging the faculty from failing students. Conclusion: Institutional faculty development programs and training workshops should facilitate the education of supervisors and assessors for timely evaluation and regular documentation of trainee assessment. The provision of legal advice in cases of appeal and professional support by the resource and support office is emphasised. الكلمات المفتاحية: التقييم, ترسيب أعضاء هيئة التدريس, ترسيب الطلاب, العجز عن الترسيب, التعليم الطبي, Keywords: Assessment, Faculty failure, Failing students, Failure to fail, Medical educatio

How does a doctor declare death?

Ward doctors in regular medical departments have to be competent in declaring the death of a patient. The majority of literature on confirmation of death focuses on special circumstances, including intensive care patients and cases involving organ donation. There is no consensus regarding the procedure and criteria for declaration of death in a 'normal' patient on a medical ward. In this article we describe the death criteria, changes that occur in the body following death, and how death can be declared in in a 'normal' patient on a medical ward and in special circumstances

Predicting 30-day mortality in intensive care unit patients with ischaemic stroke or intracerebral haemorrhage

BACKGROUND Stroke patients admitted to an intensive care unit (ICU) follow a particular survival pattern with a high short-term mortality, but if they survive the first 30 days, a relatively favourable subsequent survival is observed. OBJECTIVES The development and validation of two prognostic models predicting 30-day mortality for ICU patients with ischaemic stroke and for ICU patients with intracerebral haemorrhage (ICH), analysed separately, based on parameters readily available within 24 h after ICU admission, and with comparison with the existing Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) model. DESIGN Observational cohort study. SETTING All 85 ICUs participating in the Dutch National Intensive Care Evaluation database. PATIENTS All adult patients with ischaemic stroke or ICH admitted to these ICUs between 2010 and 2019. MAIN OUTCOME MEASURES Models were developed using logistic regressions and compared with the existing APACHE-IV model. Predictive performance was assessed using ROC curves, calibration plots and Brier scores. RESULTS We enrolled 14 303 patients with stroke admitted to ICU: 8422 with ischaemic stroke and 5881 with ICH. Thirty-day mortality was 27% in patients with ischaemic stroke and 41% in patients with ICH. Important factors predicting 30-day mortality in both ischaemic stroke and ICH were age, lowest Glasgow Coma Scale (GCS) score in the first 24 h, acute physiological disturbance (measured using the Acute Physiology Score) and the application of mechanical ventilation. Both prognostic models showed high discrimination with an AUC 0.85 [95% confidence interval (CI), 0.84 to 0.87] for patients with ischaemic stroke and 0.85 (0.83 to 0.86) in ICH. Calibration plots and Brier scores indicated an overall good fit and good predictive performance. The APACHE-IV model predicting 30-day mortality showed similar performance with an AUC of 0.86 (95% CI, 0.85 to 0.87) in ischaemic stroke and 0.87 (0.86 to 0.89) in ICH. CONCLUSION We developed and validated two prognostic models for patients with ischaemic stroke and ICH separately with a high discrimination and good calibration to predict 30-day mortality within 24 h after ICU admission.</p