A Survey of Language Diversity and Communication in Indian Academic Emergency Departments

Background Communication in the Emergency Department (ED) is particularly important given the acuity of patients and lack of prior medical history. In India, patient care is further complicated by the many spoken languages, the regional differentiation in language and the fact that medical training is primarily delivered in English. Our objective was to document language diversity among clinicians in Indian EDs linked to an international training program and explore issues related to clinician-clinician and clinician-patient communication. Methodology A cross-sectional survey of ED clinicians was conducted from May to July 2017. Survey participants were recruited via convenience sampling by a researcher at 6 ED training sites in Kerala and Karnataka. Doctors were also sent an email link to the survey. ANOVA and binary logistic regression were used to perform subgroup analysis. Results 106 clinicians completed the survey including 42 doctors (9 consultants and 33 residents), 45 nurses and 19 paramedics. On average, clinicians spoke 3. 75 languages. Fluency in the majority language at the hospital was reported by 93% of doctors, 84% of nurses and 95% of paramedics. Fluency in English was reported by 100% of doctors, 71% of nurses and 63% of paramedics. Type of clinician, age, gender, and time in clinical practice did not predict number of languages spoken or fluency in the majority language. Doctors were more likely to report fluency in English, compared to other providers (p \u3c 0. 003). 70% of clinicians reported that they used a non-English language to speak to their fellow providers most of the time. 64% felt that information was lost or changed when English medical knowledge was explained in a different language. 53% reported at least one critical incident over the last year where poor communication played a part. Time constraints, language and differences in medical knowledge were the most frequently identified barriers in these incidents. Conclusions Our study is the first to document language diversity in Indian EDs. Important findings include the common use of non-English language in clinician-clinician communication and the frequent perceived loss of information in clinician-patient communication. The reported rates of critical incidents linked to poor communication are higher than reported in comparable studies and warrant further research and action

Creation and implementation of an emergency medicine education and training program in Turkey: An effective educational intervention to address the practitioner gap

Background The specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills. Methods To address this “practitioner gap,” the authors developed a four-phase comprehensive emergency medicine education and training program for general practitioners practicing in government hospitals in Turkey. Results From April 2006 until June 2009, 42 courses were taught by 62 trainers across seven regions in Turkey. A total of 2,262 physicians were trained. The mean course pre-test score for all regions was 42.3 (95% CI 39.8 to 44.7). The mean course post-test score was 70.1 (95% CI 67.2 to 72.9). The difference between the mean scores was 27.8 (95% CI 25.3 to 30.4, P \u3c0.0001), reflecting an improvement of 65.7%. Conclusions A partnership between an academic emergency medicine department and an emergency medicine society to implement country-wide training of physicians practicing in public emergency departments can serve as a successful model for capacity-building global emergency medicine endeavors

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Utilization of and Attitudes towards Free Open Access Medical Education Resources and Social Media among Emergency Medicine Physicians in India

Background Emergency Medicine (EM) is still in its early development in much of the world, including India. Educational tools such as Free Open Access Medical Education (FOAMed) resources and social media are being used to augment learning and aid in clinical decision making in EM settings including the United States. However the utility in other settings is less well understood. The aim of the study was to characterize current usage and attitudes toward FOAMed and social media among EM physicians in India. Methods We used an online survey and in-person semi-structured interviews to collect data regarding attitudes toward and usage of FOAMed and social media. Survey invitations were sent via email to current residents and faculty. Semi-structured interviews were conducted in-person with a convenience sample of faculty and residents. Survey data was analyzed using STATA 11.0 to calculate mean responses with 95% confidence intervals (CI). Interview content was analyzed using rapid assessment methodology. Results 91 respondents completed the survey. The most commonly used resources for medical education were YouTube (70.3%, 95% CI 60.8-79.9%), WhatsApp (59.3% 95% CI 49.1-69.6%), and Facebook (36.3% (95% CI 26.2- 46.3%). These resources are reportedly used at least daily or numerous times per week by almost half of all respondents. Approximately 70% of respondents reported at least one barrier to the usage of FOAMed or social media, including cost (28.6% [95%CI 19.1-38.0%]), blocked websites (19.8% [95%CI 11.4-28.1%]) and internet connectivity (18.7% [95% CI 10.5-26.8%]). 103 interviews were conducted. Common themes included the ease of sharing knowledge and clinical information via social media. Many respondents reported using WhatsApp to expedite patient care when consultants were not readily available, and to answer clinical questions in real time. Respondents also described using social media to expand learning in unusual cases. Advanced residents and consultants were more likely to describe importance of FOAMed resources as adjuncts to basic learning tool such as textbooks. Conclusions Most EM trainees and faculty in India are aware that Free Open Access Medical Education resources exist, though familiarity with the term was variable. Trainees expressed a need for resources specifically focused on India or Low and Middle Income Countries (LMICs)