Breaking Bad News for Anesthesia Residents: A Validity Study of a Simulation Based Education Intervention

Background: Breaking bad news (BBN) to patients and their relatives is a complex task. The structure, training methods or evaluation instruments that are best used to teach and assess BBN to anesthesiology residents are still unclear. The purpose of this study is to examine the validity evidence supporting the use of a previously published ‘‘GRIEV_ING” assessment tool in measuring the acquisition of BBN skills for anesthesiology residents after an educational intervention. Methods: Sixteen third and fourth-year residents participated in this study. The GRIEV_ING” checklist was modified, pilot tested and reviewed by content experts to accommodate the anesthesia context. Examiners and standardized patiens (SPs) underwent frame-of-reference training sessions in preparation for their roles. BBN skills were assessed via videotaped SP encounters after immersive scenarios, at baseline and immediately post-intervention with two different cases. A communication global rating and the GRIEV_ING” assessment tool were used. Residents’ perception about their own ability and comfort for BBN were collected using the pre and post workshop surveys. A focus group interview was conducted. Inter-rater reliability was evaluated by intraclass correlation coefficient (ICC). Internal-consistency reliability and correlation between the two assessments instruments was calculated. An item analysis for the GRIEV_ING scale was conducted. Differences in performance, based on the years of training, and previous experience or training were compared. Results: ICCs for both cases indicated good inter-rater reliability for the GRIEV_ING checklist and a good internal-consistency reliability for both assessment instruments was found. Item analysis on the GRIEV_ING checklist items showed that 40.7% of items had an excellent discrimination power. Performance did not show significant differences when based on years of training, previous training or experience. Concepts from the focus group discussions were organized into categories that included residents' perceived barriers to BBN; strategies for BBN, strengths of the education intervention and training needs. Conclusions: Findings from this study indicate that BBN is a teachable skill. The evaluation of our education intervention provides validity evidence to illustrate the value of integrating BBN into the curriculum of the anesthesiology residents, which has led to improved learner performance

Medical education in a foreign language and history-taking in the native language in Lebanon – a nationwide survey

Abstract Background With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students’ confidence in their history-taking skills in their native language. Methods This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n = 457). Results The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels. Conclusions Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language

<i>CHAMP1</i>-Related Disorder: Sharing 20 Years of thorough Clinical Follow-Up and Review of the Literature

Intellectual disability (ID) is a prevalent neurodevelopmental disorder characterized by limitations in intellectual functioning and adaptive behavior. While the causes of ID are still largely unknown, it is believed to result from a combination of environmental exposures and genetic abnormalities. Recent advancements in genomic studies and clinical genetic testing have identified numerous genes associated with neurodevelopmental disorders (NDDs), including ID. One such gene is CHAMP1, which plays a role in chromosome alignment and has been linked to a specific type of NDD called CHAMP1 disease. This report presents the case of a 21-year-old Lebanese female patient with a de novo mutation in CHAMP1. In addition to ID and NDD, the patient exhibited various clinical features such as impaired language, dysmorphic features, macrocephaly, thoracic hyperkyphosis, decreased pain sensation, and metabolic syndrome. These findings expand the understanding of the clinical spectrum associated with CHAMP1 mutations and highlight the importance of comprehensive follow-up for improved prognosis. Overall, this case contributes to the knowledge of CHAMP1-related NDDs by describing additional clinical features associated with a CHAMP1 mutation. The findings underscore the need for accurate diagnosis, thorough follow-up, and personalized care for individuals with CHAMP1 mutations to optimize their prognosis