Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - A randomised, controlled simulation study of two micro-interventions

<p>Abstract</p> <p>Background</p> <p>Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork.</p> <p>Aim</p> <p>To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio.</p> <p>Methods</p> <p>Participants: 46 physicians graduated within 5 years. Design: A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer.</p> <p>Results</p> <p>Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action".</p> <p>Conclusion</p> <p>Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment.</p

Skills Training in Laboratory and Clerkship: Connections, Similarities, and Differences

Context: During the third semester of a 6 year long curriculum medical students train clinical skills in the skills laboratory (2 hours per week for 9 weeks) as well as in an early, 8 week clinical clerkship at county hospitals. Objectives: to study students’ expectations and attitudes towards skills training in the skills laboratory and clerkship. Subjects: 126 medical students in their 3rd semester. Methods: During the fall of 2001 three consecutive, constructed questionnaires were distributed prior to laboratory training, following laboratory training but prior to clerkships, and following clerkships respectively. Results: Almost all (98%) respondents found that training in skills laboratory improved the outcome of the early clerkship and 70% believed in transferability of skills from the laboratory setting to clerkship. Still, a majority (93%) of students thought that the clerkship provided students with a better opportunity to learn clinical skills when compared to the skills laboratory. Skills training in laboratory as well as in clerkship motivated students for becoming doctors. Teachers in both settings were perceived as being committed to their teaching jobs, to demonstrate skills prior to practice, and to give students feed back with a small but significant more positive rating of the laboratory. Of the 22 skills that students had trained in the laboratory, a majority of students tried out skills associated with physical examination in the clerkship, whereas only a minority of students tried out more intimate skills. Female medical students tried significantly fewer skills during their clerkship compared to male students. Conclusions: Students believe that skills laboratory training prepare them for their subsequent early clerkship but favour the clerkship over the laboratory

Hvad findes der af litteratur om vejledning? – Litteratursøgning med fokus på publicerede, evidensbaserede studier

Vejledningen i universitetsregi lever et usynligt liv. Den er ikke formelt beskrevet på universiteterne, og den foregår i det, som både vejledere og studerende opfatter som et intimt rum. Men hvad findes der egentlig af erfaringsbaseret litteratur på området? I denne artikel beskriver artiklens forfattere resultaterne af en litteratursøgning, som de har udført i danske,nordiske og internationale databaser

Studieplanlægning ved lægeuddannelserne

undersøgte lektorers og undervisningsansvarliges rolle i studieplanlægning ved de tre danske lægeuddannelser. Under individuelle og fokusgruppe-interviews pegede informanterne på studieleders helt centrale rolle og lektorers klart perifere rolle. Lektorernes deltagelse blev beskrevet som personafhængig, båret af ildsjælene. Denne artikel tilbyder et første empiriskgrundlag for at diskutere studieplanlægningspraksis

Conveying clinical reasoning based on visual observation via eye-movement modelling examples

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2012). Conveying clinical reasoning based on visual observation via eye-movement modelling examples. Instructional Science, 40(5), 813-827. doi:10.1007/s11251-012-9218-5Complex perceptual tasks, like clinical reasoning based on visual observations of patients, require not only conceptual knowledge about diagnostic classes but also the skills to visually search for symptoms and interpret these observations. However, medical education so far has focused very little on how visual observation skills can be efficiently conveyed to novices. The current study applied a novel instructional method to teach these skills by showing the learners how an expert model visually searches and interprets symptoms (i.e., eye-movement modelling examples; EMMEs). Case videos of patients were verbally explained by a model (control condition) and presented to students. In the experimental conditions, the participants received a recording of the model’s eye movements superimposed on the case videos. The eye movements were displayed by either highlighting the features the model focused on with a circle (the circle condition) or by blurring the features the model did not focus on (the spotlight condition). Compared to the other two conditions, results show that a spotlight on the case videos better guides the students’ attention towards the relevant features. Moreover, when testing the students’ clinical reasoning skills with videos of new patient cases without any guidance participants studying EMMEs with a spotlight showed improved their visual search and enhanced interpretation performance of the symptoms in contrast to participants in either the circle or the control condition. These findings show that a spotlight EMME can successfully convey clinical reasoning based on visual observations

Learning perceptual aspects of diagnosis in medicine via eye movement modeling examples on patient video cases

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010). Learning perceptual aspects of diagnosis in medicine via eye movement modeling examples on patient video cases. In S. Ohlsson & R. Catrambone (Eds.), Proceedings of the 32nd Annual Conference of the Cognitive Science Society (pp. 1703-1708). Austin, TX: Cognitive Science Society.Complex tasks with a visually rich component, like diagnosing seizures based on patient video cases, not only require the acquisition of conceptual but also of perceptual skills. Medical education has found that besides biomedical knowledge (knowledge of scientific facts) clinical knowledge (actual experience with patients) is crucial. One important aspect of clinical knowledge that medical education has hardly focused on, yet, are perceptual skills, like visually searching, detecting, and interpreting relevant features. Research on instructional design has shown that in a visually rich, but simple classification task perceptual skills could be conveyed by means of showing the eye movements of a didactically behaving expert. The current study applied this method to medical education in a complex task. This was done by example video cases, which were verbally explained by an expert. In addition the experimental groups saw a display of the expert’s eye movements recorded, while he performed the task. Results show that blurring non-attended areas of the expert enhances diagnostic performance of epileptic seizures by medical students in contrast to displaying attended areas as a circle and to a control group without attention guidance. These findings show that attention guidance fosters learning of perceptual aspects of clinical knowledge, if implemented in a spotlight manner

Role and Development of Perceptual Skills in Medical Education

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010, May). Role and Development of Perceptual Skills in Medical Education. The Scandinavian Workshop on Applied Eye-Tracking (SWAET), Lund, Sweden.This talk is about a study in which we tried to convey perceptual skills in clinical reasoning on patient video cases

Fostering perceptual skills in medical diagnosis

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010, August). Fostering perceptual skills in medical diagnosis. Meeting of the EARLI SIG6/7 Instructional Design and Learning and Instruction with Computers, Ulm, Germany.Perceptually demanding tasks, like diagnosing seizures based on patient video cases, not only require the acquisition of conceptual but also of perceptual skills; like visually searching and interpreting relevant features. Showing the eye movements of a didactically behaving expert conveyed perceptual skills in a perceptually demanding, but conceptually simple task. The current study applied this method to medical education – a conceptually complex task – by example videos, which were verbally explained by an expert. In addition the experimental groups saw a display of the expert's eye movements recorded, while he performed the task. Results show that blurring non-attended areas of the expert guides the attention of the students during example study, leads to enhanced visual search and interpretation of relevant features in contrast to displaying attended areas as a circle and to a control group without attention guidance. Thus, spotlight attention guidance fosters learning of perceptual skills in medical diagnosis