1-month Rotation Research Articles

Resident Training in Developmental/Behavioral Pediatrics: Where Do We Stand?

Approximately 25% to 30% of all complaints to a general pediatrician are developmental or behavioral in origin. Despite this, residency education in developmental/behavioral pediatrics has consistently been rated poorly. Changes were set forth in 1997 to include a mandatory 1-month block rotation in developmental/behavioral pediatrics. This study was a nationwide, cross-sectional, self-administered, mailed survey of pediatricians who completed residency either before or after these changes went into effect. Overall, pediatricians' comfort level in developmental/behavioral pediatrics was unchanged in the 2 groups. Certain areas (behavior problems, learning disabilities, sleep, and depression/anxiety) of developmental/behavioral pediatrics had lower comfort scores. Our data provide direction for the ongoing refinement of pediatric education that is based on feedback from currently practicing pediatricians.

Characterizing Novice Behavior Associated With Learning Ultrasound-Guided Peripheral Regional Anesthesia

Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new technique. In addition to assessing for both committed errors and accuracy, we aimed to identify previously unrecognized quality-compromising behaviors that could help structure effective training interventions. By using detailed video analyses, the performances of 6 anesthesia residents were evaluated while on a dedicated 1-month rotation in ultrasound-guided regional anesthesia. From these video reviews, we assessed accuracy, errors committed, performance times, and searched for previously unrecognized quality-compromising behaviors. A total of 520 nerve blocks were videotaped and reviewed. All residents performed at least 66 nerve blocks, with an overall success rate of 93.6% and 4 complications. Both speed and accuracy improved throughout the rotation. There were a total of 398 errors committed, with the 2 most common errors consisting of the failure to visualize the needle before advancement and unintentional probe movement. Five quality-compromising patterns of behavior were identified: (1) failure to recognize the maldistribution of local anesthesia, (2) failure to recognize an intramuscular location of the needle tip before injection, (3) fatigue, (4) failure to correctly correlate the sidedness of the patient with the sidedness of the ultrasound image, and (5) poor choice of needle-insertion site and angle with respect to the probe preventing accurate needle visualization. Based on the analysis of the committed errors and the identification of quality-compromising behaviors, we are able to recommend important targets for learning in future training and simulation programs.

Are Medical Students Assigning Proper Global Assessment of Functioning Scores?

This article seeks to determine whether medical students can estimate the appropriate score for the Global Assessment of Functioning (GAF) compared with psychiatry residents and staff psychiatrists. The authors hypothesized that medical students' estimations of GAF scores for patients in clinical vignettes would differ from those assessed by the psychiatry residents and staff psychiatrists. The authors designed a cross-sectional confidential survey of medical students, psychiatry residents, and staff psychiatrists. Consenting participants were asked to provide demographic information and then complete the accompanying questionnaire after reading two vignettes. One of the vignettes described a depressed patient and the other a psychotic patient. The subjects were asked to estimate the GAF scores for the patients in both vignettes. Then the subjects were given the GAF scoring guide to review and were asked to re-assess their initial GAF scores for the patients in the vignettes. Medical students assigned much higher GAF scores for the patient in the vignette with less severe symptoms than the psychiatry residents and staff psychiatrists. The GAF scores of all three groups for the patient in the vignette with more severe symptoms were comparable. The ability of medical students to assign proper GAF scores needs to be studied further. Our study suggests that current 1-month rotations in psychiatry, without specific training on assigning GAF scores, may not provide medical students with enough information to assess GAF scores accurately. This might need to be addressed in psychiatry clerkships.

Individual didactic sessions or group lectures for teaching the foot and ankle to orthopaedic residents

The relative efficacy of individual didactic sessions or group lectures in teaching the foot and ankle to orthopaedic residents is unknown. Ten fourth year (R4) orthopaedic residents received individual didactic teaching sessions during a 1-month foot and ankle rotation, and 12 fifth year (R5) orthopaedic residents who had no foot and ankle rotation received a series of group lectures. Foot and ankle knowledge level was evaluated before and after the teaching programs with multiple choice tests. The average test score for all residents was significantly improved from before to after the teaching programs (all residents: pre-test, 51 ± 11%; post-test, 66 ± 8%; P < 0.0001). There was no difference between the R4 and R5 resident groups in average pre-test score or post-test score. The improvement in test scores from the pre-test to the post-test was similar for the R4 and R5 resident groups. Individual didactic sessions and group lectures were equally effective in encouraging learning and improving knowledge level of the foot and ankle. The key factors in significantly improving knowledge of the foot and ankle were the presence of a formal teaching program to stimulate learning and the availability of an active Foot and Ankle Service with dedicated attending foot and ankle subspecialist surgeons.

Changing of the Guard in Pittsburgh: C. Richard Bennett, DDS, PhD, Retires

Leonard Monheim graduated from the University of Pittsburgh School of Dental Medicine in 1933 and then signed up for a 1-year hospital internship at the University of Cincinnati. After spending a 1-month rotation in anesthesia under the direction of Frances Foldes, MD, he was forever hooked on anesthesia as a career. Dr Monheim spent the next 3 years with Dr Foldes learning to be an anesthesiologist before returning to Pittsburgh to begin his anesthesia practice. From 1942 to 1946, Dr Monheim served in the US Army and was stationed in the Philippines, where he taught intravenous deep sedation techniques called chemamnesia to Army Corpsmen. Upon his return to Pittsburgh, Dr Monheim was the only trained anesthesiologist in Presbyterian Hospital for many years. He founded the Department of Anesthesiology at the dental school, the first in any dental school in the United States, and developed a 1-or 2-year general anesthesia residency for dentists. Along with several other visionaries, including Ohio State’s Morgan Allison, he was one of the founding fathers of the American Dental Society of Anesthesiology in 1953.C. Richard Bennett, DDS, PhD, graduated from dental school at The Ohio State University in 1963, where he learned the basics of anesthesia, pain, and anxiety control from Morgan Allison. He then studied anesthesiology and pharmacology under Dr Monheim at the University of Pittsburgh and received a PhD degree from that institution in 1967. Dr Bennett subsequently joined the faculty at the University of Pittsburgh School of Dental Medicine in the Department of Anesthesiology, which was still under the pioneering leadership of Dr Monheim. Upon Dr Monheim’s untimely death in 1971, Dr Bennett assumed the chairmanship of the department and has remained in that position for the past 35 years. During that time, Dr Bennett trained scores of dentist anesthesiologists in his general anesthesiology residency that eventually became a 3-year program, and he educated thousands of dental students to understand the huge need and demand for advanced anesthesia training for dentists. In addition to his duties in the dental school, Dr Bennett also served as a staff anesthesiologist at the University of Pittsburgh Medical Center hospitals for 25 years. He authored 5 textbooks and was a contributing author to 20 other textbooks on anesthesia and related topics. He has also lectured extensively in North America, Central America, and South America as well as in Europe, Asia, Africa, and Russia. He is now retiring as professor and chairman of the Department of Anesthesiology at the University of Pittsburgh School of Dental Medicine after spending the past 43 years there as a resident, graduate student, and faculty member.Fortunately, 2 of his former residents have been recruited to ensure that the Monheim-Bennett anesthesiology program legacy will continue to flourish. Paul A. Moore, DMD, PhD, MPH, has been named chair of the Department of Anesthesiology to succeed Dr Bennett. Dr Moore earned a DMD, PhD in Pharmacology, and Masters degree in Public Health in Epidemiology and completed an anesthesiology residency, all in Pittsburgh. He is widely known for his research abilities and has received the International Association for Dental Research’s prestigious Distinguished Scientist Award. He serves on the editorial board of the Journal of the American Dental Association and has authored more than 125 articles on clinical pharmacology and dental therapeutics in peer-reviewed journals.Another illustrious Pittsburgh-trained dentist anesthesiologist is Joseph Giovannitti, DMD, who developed a very successful private practice of anesthesiology for patients of other dentists in the Dallas–Fort Worth area before being lured back to Pittsburgh. He sold his practice and has been hired full time in the anesthesia department as the anesthesia director of the new special needs clinic, which should be ready for patients within the year. Dr Giovannitti is a former member of the board of directors of the American Dental Board of Anesthesiology and received the Monheim Award in 2002, the highest honor bestowed by the American Society of Dentist Anesthesiologists. He is a highly experienced anesthesia clinician who also has research and publication experience.We should all be very thankful for all that C. Richard Bennett has done for anesthesiology in dentistry. We congratulate him for keeping a bright flame burning on the candle of anesthesiology training for dentists that Leonard Monheim lit so many years ago. With this changing of the guard, we trust that Dr Moore, Dr Giovannitti, and others will continue the tradition that has been a distinguishing characteristic of the University of Pittsburgh School of Dental Medicine for more than 50 years. Richard, congratulations for a job well done. Your program is in good hands. Enjoy your retirement.

Part II: Preparing and Assessing First-Year Radiology Resident On-Call Readiness: Technical Implementation

The effectiveness of using a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system in evaluating the readiness of first year radiology residents before taking overnight call in the emergency department (ED) was reported in part I of this article. This report describes technical aspects for the design and implementation of this system. The examination system consists of two modules: Data Collection and Image Viewing. The Data Collection module was a personal computer (PC)-based DICOM storage server based on a free public domain software package, the Mallinckrodt Central Test Node. The Image Viewing module was a Java-based DICOM viewer created using another freeware package: zDicom ActiveX component. The examination takes place once a year at the end of the first 6-month rotation. Cases selected for the examination were actual clinical cases according to the American Society of Emergency Radiology core curriculum. In the 3-hour timed examination, each resident was required to read the cases and provide clinical findings and recommendations. Upper-level residents also participated in the examination to serve as a control. Answers were scored by two staff radiologists. We have been using this examination system successfully in our institution since 2003 to evaluate the readiness of the first-year residents before they take overnight call in the ED. This report describes a step-by-step procedure for implementing this system into a PC-based platform. This DICOM viewing software is available as freeware to other academic radiology institutions. The total cost for implementing this system is approximately 2000 US dollars.

THE SURGICAL TRAINEE LOG WE NEED: MINIMUM OF WORK, MAXIMUM OF OUTPUT

The objective of this study was to design a trainee logbook suitable for both surgical training and surgical audit. The fields of the logbook should conform to both the current requirements for surgical trainee logbooks and the minimum and recommended datasets for surgical audit. The database should be able to share information with other databases including hospital information systems. The current logbook requirements do not include much outcome data. Therefore, keeping the logbook does not train the young surgeon to collect all the information necessary for surgical audit, particularly the recently promoted minimum (12 fields) and recommended (22 fields) datasets. An electronic logbook was developed as part of the hospital's clinical information system (CORDis). Patient identifier information was available in the system and did not need to be re-entered (e.g. name, number, date of birth and sex). The trainee only input the necessary fields for his/her logbook and was able to derive information already available from CORDis on complications, outcome and final diagnosis of the patient. Thirteen of 16 trainees used the program over a period of 2.5 years, and more than 4600 operative procedures were recorded. Information on outcome and complications was included in the logbook, regardless of who in the team entered the data. This also facilitated surgical audit presentations. Logbook reports for the Advanced Training Board were produced with the click of a mouse rather than by spending a whole weekend counting items in the operation register at the end of a 6-month rotation. This system could be used at different hospitals or the data can be exported to another database including databases on a hand-held device. The logbook contains all the data for reporting to the Specialty Training Board and Surgical Audit. Duplication of data entry was reduced, and presentation of unit/trainee surgical audits was facilitated. The data can be exchanged with other common databases when the trainee rotates out of Geelong.

Radiation effects and shielding requirements in human missions to the moon and Mars

Background: Radiation in space poses a threat to humans embarked on missions to the Moon or Mars. Several studies deal with allowable doses, levels of radiation doses in space, and effects of various forms of shielding. The recent shift in emphasis from to 95% confidence intervals adds significantly to the challenge in designing human space missions. Recent reports issued by NASA as well as the Exploration Systems Architecture Study (ESAS) have estimated radiation effects for some mission scenarios. Nevertheless, radiation effects and the effectiveness of shielding remain uncertain. Method: Models and data in the literature are reviewed, and comparisons are made between allowable dose and estimated dose for lunar and Mars missions. Appraisals are made of the feasibility of providing radiation protection for crews in human missions to the Moon and Mars. A number of investigators have prepared point estimates of the doses due to galactic cosmic radiation (GCR) or solar particle events (SPE) for specific locations in space. However, the current NASA trend is to utilize the 95th percentile confidence interval (CI) rather than the point estimate for dose. In cases where the 95% CI has been modeled, the 95% CI dose is typically 3 to 4 times the point estimate. We have therefore multiplied point estimates by ~3.5 to roughly approximate 95% CI estimates, and compared them with allowable doses for various cases: (a) in space, (b) in space behind shields, (c) on the lunar surface behind various shields or within habitats, and (d) on the surface of Mars behind shields or within habitats. Conclusion: For lunar sortie missions, the duration is short enough that GCR creates no serious risks. For lunar outpost missions the probability of encountering an SPE during Solar Maximum in a 6-month rotation is 1% to 10% depending on the assumed energy of the SPE. Even with > 30 g/cm of regolith shielding the 95% CI dose from a major SPE would exceed the 30-day limit. The GCR during Solar Minimum for a 6-month stay on the Moon is marginal against the annual limit, but this can be mitigated somewhat by use of regolith for shielding the habitat. For Mars missions, we conjecture a 400-day round trip transit to and from Mars, and about 560 days on the surface. The GCR 95% CI GCR dose equivalent with 15 g/cm of aluminum shielding during Solar Minimum is about double the allowable annual dose for each leg of the trip to and from Mars. If a major SPE occurred during a transit, the crew would receive a sufficient dose to reduce their life expectancy by more than the 3% limit. The probabilities of encountering a large SPE are ~2.4% for a 4X 1972 SPE and about 20% for a 1X 1972 SPE in a round trip of 400 days during Solar Maximum. On the surface of Mars, the accumulated GCR 95% CI dose over the course of a year is about 77 cSv, which exceeds the annual allowable of 50 cSv. For a 560-day stay on Mars, the cumulative 95% CI dose is about 120 cSv. This would exceed the career allowable dose for most females and younger males. The 95% CI dose from a major SPE would exceed the 30-day allowable dose. The probabilities of encountering a large SPE are ~3.4% for a 4X 1972 SPE and ~28% for a 1X 1972 SPE for 560 days on the surface during Solar Maximum.

Evaluation of Inpatient Clinical Training in AIDS Care

Studies of outpatient clinical training in AIDS care have shown positive effects on residents' knowledge, attitudes and intentions. In this study, residents' knowledge, attitudes and intentions regarding the care of HIV-infected patients were used as outcome measures to evaluate the effectiveness of a 1-month residency training in an AIDS inpatient unit. From April 2000 through April 2001, 33 internal medicine residents completed pretest-posttest questionnaires evaluating changes in their knowledge, attitudes and intention to care for HIV-infected patients. Of these 33 residents, 25 participated in a posttest interview, reflecting on their learning experience during the 1-month clinical rotation. At the posttest, residents were significantly more accurate in assessing HIV-associated risk (p < 0.001), and were significantly more knowledgeable about the necessary protective equipment to prevent HIV transmission (p < 0.01). Residents were significantly less concerned about the risk of infection (p < 0.01) and interpersonal concerns (p < 0.05). Residents' reluctance to care for HIV-infected patients was significantly lower (p < 0.05), as was their tendency to avoid invasive procedures or treatment of HIV-infected patients (p < 0.001). Residents designated after their training were more likely to practice universal precautions and less likely to be afraid and to stereotype HIV-infected patients. They also reported gaining insight into HIV diseases and patients' multifaceted needs, and appreciating the importance of teamwork in AIDS care. A 1-month AIDS residency training can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.

Integrating Accreditation Council for Graduate Medical Education (ACGME) competencies: a novel approach undertaken in the preoperative assessment clinic

surveys of recent graduates from our program have identified a need for an introduction to the skills necessary to accomplish excellent patient care with efficiency in this setting. Introduced in July 2004, senior residents, under close supervision by the attending anesthesiologist, are performing a supervisory role—the junior attending—in the management of a 4-room outpatient/short-stay surgical unit. During this 1-month rotation, they gain valuable experience with regard to all aspects of perioperative management and case coordination. The curriculum is novel and under development. Methods: The senior resident received an orientation with literature pertaining to the supervision of nurse anesthetists, including American Society of Anesthesiologists position statements [1] and financial [2] practice information. Clinical activities included evaluation of each patient and discussion of the plan with attending staff and the nurse anesthetist. They supervised all perioperative management. In consultation with the nurse managers, they coordinated cases and personnel to improve the efficiency of the unit. At the conclusion of the day, the faculty member and resident reviewed the events of the day, and feedback was obtained. The residents were evaluated for medical knowledge and patient care. They were also evaluated for the efficient organization and implementation of anesthetic management at multiple sites and communication skills with nursing and surgical teams. A 360-degree evaluation is in preparation, including patient satisfaction. The residents evaluated the rotation. Results: Six residents have participated in the rotation. Residents report high satisfaction in developing autonomy and developing important communication skills that facilitate working within the banesthesia teamQ model. Their satisfaction is proportional to their autonomy. In addition, residents stated that this rotation has greatly enhanced their ability to multitask and manage personnel. Discussion: Improving the resident’s understanding of varied types of anesthesia practice is a goal of resident training. In the rotation under development, we have exposed the senior resident to the responsibility of certified registered nurse anesthetist supervision in the multiple location setting. It is expected that this experience will improve the resident’s understanding of the system-based practice and communication skills essential to this setting. It will help in career decisions and prepare them for efficient and safe operating room management.

Psychological Screening Procedures for Deploying U.S. Forces

This study examined the validity of psychological measures used in screening for the U.S. Army with 885 soldiers before a 6-month peacekeeping rotation in Kosovo. Content validity and construct validity were assessed by evaluating the clinical domains, comparing clinician assessments of functioning, and assessing risk factors for screening positive. Construct validity and content validity were demonstrated. Risks, benefits, and future directions of the Army's psychological screening research program are discussed.

Establishing Learning Curves for Surgical Residents Using Cumulative Summation (CUSUM) Analysis

The assessment of technical proficiency is of paramount importance in the training of surgical residents. The fact that technical proficiency is underrepresented in the context of the ACGME outcomes project is evidenced in that proficiency skills comprise less than 5% of all assessments that evaluate residents. In this study, we use Cumulative Summation Analysis (CUSUM) as a visual objective analytic tool to determine performance accuracy and establish learning curves for PGY-1s in surgery. From April 2001 to May 2002, 11 surgical residents completed a 1-month anesthesia rotation. Each resident was asked to complete a preoperative airway assessment followed by endotracheal intubation with induction of anesthesia. Airway assessment was performed independently by a resident and a licensed anesthesiologist or certified anesthetist with the modified Mallampati Score. Data were sequentially collected and plotted for summated successes and failures. The average intern required approximately 19 intubation attempts to complete the learning curve experience. There was no learning curve for airway assessment. The CUSUM analysis is an effective objective tool to define learning curves for technical skills. Vital information is provided for surgical programs that place residents in positions to manage airways, and limitless potential for defining the learning curves for technical skills is provided.

A Small-Scale Foreign Aid Strategy

Donor nations send billions of dollars of aid to developing countries with little evidence for lasting positive effects ([1][1]). It is clear that more effective aid programs must be conceived that will have an enduring impact in spite of the difficult conditions prevailing in recipient nations ([2][2], [3][3]). Small-scale efforts can make contributions to the global aid effort. I wish to share my experiences with one small organization that has achieved remarkable success with limited financial resources and a structure that demands only a modest commitment from the individual participants. “Cooperation Geneve-Yaounde” (CGY) is an alliance between the medical faculties of the Universities of Geneva, Switzerland, and Yaounde, Cameroon, whose primary goal is to improve the training of Cameroonian medical doctors. Two guiding principles of the CGY are that raising the standards of medical practice will have an immediate impact on the health of a population and that aid provided in the form of educational training is relatively immune to misappropriation and corruption. Volunteers from Swiss medical faculties actively collaborate in the teaching and evaluation of medical students at the University of Yaounde. Although each Swiss participant devotes only a period of 2 to 3 weeks of teaching per year, the students and local staff members also benefit greatly from the opportunities to interact informally with the foreign medical professionals. The CGY organizes residency training in Swiss hospitals for young Cameroonian doctors committed to returning into active practice in their native regions. A major challenge facing programs that train healthcare workers in developing countries is the drain of graduates to countries offering higher salaries and a vastly superior work environment ([4][4]). The CGY has been fortunate in that all but one of the over 60 Cameroonian doctors selected for residency training in Geneva subsequently returned to work in their native country. This success rate reflects the requirement that candidates must have already completed an internship in Cameroon, as doctors trained entirely in our medical system will find it extremely difficult to adapt to working in African hospitals. The medical faculty in Cameroon hosts 10 medical students from Geneva every year for a 2-month rotation in tropical medicine and community health. Apart from providing a unique opportunity to experience a different culture and its distinctive attitudes to health and disease, firsthand exposure to the daily frustrations encountered in African hospitals sensitizes these future Western doctors to our humanitarian obligations in the developing world. I believe that this conceptually straightforward program can serve as a useful model for universities with an interest in contributing to education in poorer nations. 1. 1.[↵][5] “How to make Africa smile. A survey of sub-Saharan Africa,” Economist , 17 Jan. 2004, pp. 1–16. 2. 2.[↵][6] 1. E. M. Einterz , Lancet 357, 1524 (2001). [OpenUrl][7][CrossRef][8][PubMed][9][Web of Science][10] 3. 3.[↵][11] 1. R. Klitgaard , Tropical Gangsters (Basic Books, New York, 1990). 4. 4.[↵][12] 1. C. Schubert , Nature Med. 9, 979 (2003). [OpenUrl][13][CrossRef][14][PubMed][15][Web of Science][16] [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #xref-ref-1-1 View reference 1. in text [6]: #xref-ref-2-1 View reference 2. in text [7]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DEinterz%26rft.auinit1%253DE.%2BM.%26rft.volume%253D357%26rft.issue%253D9267%26rft.spage%253D1524%26rft.epage%253D1525%26rft.atitle%253DInternational%2Baid%2Band%2Bmedical%2Bpractice%2Bin%2Bthe%2Bless-developed%2Bworld%253A%2Bdoing%2Bit%2Bright.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252800%252904640-7%26rft_id%253Dinfo%253Apmid%252F11377628%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=10.1016/S0140-6736(00)04640-7&link_type=DOI [9]: /lookup/external-ref?access_num=11377628&link_type=MED&atom=%2Fsci%2F307%2F5714%2F1410.1.atom [10]: /lookup/external-ref?access_num=000168614300039&link_type=ISI [11]: #xref-ref-3-1 View reference 3. in text [12]: #xref-ref-4-1 View reference 4. in text [13]: {openurl}?query=rft.jtitle%253DNature%2Bmedicine%26rft.stitle%253DNat%2BMed%26rft.aulast%253DSchubert%26rft.auinit1%253DC.%26rft.volume%253D9%26rft.issue%253D8%26rft.spage%253D979%26rft.epage%253D979%26rft.atitle%253DNurses%2Bdisappearing%2Bfrom%2Bdeveloping%2Bnations.%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fnm0803-979%26rft_id%253Dinfo%253Apmid%252F12894140%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [14]: /lookup/external-ref?access_num=10.1038/nm0803-979&link_type=DOI [15]: /lookup/external-ref?access_num=12894140&link_type=MED&atom=%2Fsci%2F307%2F5714%2F1410.1.atom [16]: /lookup/external-ref?access_num=000184484900002&link_type=ISI

Specific training in clinical forensic medicine is useful to ACEM trainees

To assess the effectiveness of a 6-month rotation in forensic medicine in developing medicolegal and forensic skills for doctors training for a fellowship with the Australasian College for Emergency Medicine (ACEM). Over a period of 6 years 12 trainees undertook a 6-month rotation with the Victorian Institute of Forensic Medicine (VIFM) as a clinical forensic registrar. These 12 trainees were surveyed and asked structured questions regarding their perception of the usefulness of the training and the impact of the rotation on their professional development. Twelve replies were received (100% response rate). All respondents felt that the term had a major positive influence on their ability to examine victims of physical and sexual assault, obtain forensic specimens and prepare a medicolegal report. A 6-month rotation in clinical forensic medicine improves ACEM trainees perceived ability to perform a number of medicolegal tasks without interfering with other areas of professional development.

The influence of an emergency medicine ultrasonography program on the ranking of senior medical students who choose emergency medicine residencies: A prospective survey

Study objectives: We assess the importance of an active ultrasonography program on residency program selection among senior medical students applying to enter an emergency medicine residency. Methods: This institutional review board–approved, prospective survey was sent by electronic mail to 250 senior medical students who had submitted their e-mail address to our emergency medicine residency program (subsequent to match list submission). The survey consisted of 12 questions pertaining to how the inclusion of an active ultrasonography program influenced their residency match list choices. Results: A total of 62 (25%) senior medical students responded. (A small number of surveys were returned unanswered because of e-mail address changes.) Ninety-four percent of the senior medical students stated that an active ultrasonography program was a priority to them. The majority (80%) stated that an active ultrasonography program was either somewhat important (53%) or extremely important (27%) in their ranking of an emergency medicine residency program. Sixty-two percent stated that if the emergency medicine residency program did not have an ultrasonography machine in the emergency department, they would change their program choice, and 66% said that they would not rank the program "highly." Seventy-four percent stated that an ultrasonography rotation would be a priority in their training, and 55% stated that it was an influencing factor in their decision to rank emergency medicine residency programs. Additionally, 53% stated that a 1-month rotation was desirable. Ninety percent stated that ultrasonography was either very important (56%) or extremely important (34%) to the emergency practice, although faculty without credentials or who had not published did not affect ranking of emergency medicine residency programs, 97% and 100%, respectively. The ultrasonographic techniques stated to be most important are as follows; echo/cardiac tamponade (95%), right upper quadrant ultrasonography/hepatobiliary disease (92%), pneumothorax/pleural effusion (75%), central venous access (61%), paracentesis (56%), and gastric content assessment for sedation (37%). Conclusion: Emergency medicine residency applicants are greatly influenced by an active ultrasonography program, and it is a major determinant in the decision to rank a program more highly.

Resident training in advanced airway management

Management of the difficult airway is an essential skill that should be taught during an anesthesiology residency. However, only a minority of anesthesiology residency programs have formal rotations in advanced airway management. We developed a formal advanced airway rotation as an integral part of our residency program, consisting of two 1-month rotations during the residency, each with a separate focus. While on the advanced airway rotation, the resident anesthesiologist is given a set of objectives, a list of required reading, and a required number of procedures unique to advanced airway management that they must perform during the rotation. We believe that this rotation has been beneficial in improving the residents' exposure to advanced airway techniques, and has dramatically improved their capabilities in this important aspect of anesthetic of anesthetic training. Additionally, the structure of the rotation ensures uniformity in the residents' acquisition of advanced airway skills.

Essential Neurology: Audiovisual Patient Vignettes on CD-ROM as a Teaching Aid for Medical Students

To assess third- and fourth-year medical students’ opinions in the use of previously recorded and edited live patient interviews as a teaching tool during a 1-month clinical neurology rotation. The global burden of neurological disease is on the rise and is projected to reach nearly 15% by the year 2020. The amount of time devoted to neurologic education during medical school is limited. To expand the range of neurologic problems to which students are exposed, we have compiled an archive of 100 audiovisual case vignettes on CD-ROM which students view during their neurology clerkship. The vignettes served as a tool for our former Departmental Chairman (Dr Biller) to discuss diagnosis, ancillary testing, and basic patient management skills with third- and fourth-year medical students during interactive case conferences. A survey conducted among students regarding the vignettes reflects a high degree of approval. Ninety-two percent of the students rated the overall experience with the case vignettes as either “excellent” or “good.” CD-ROM case vignettes are felt to represent a novel way of expanding students’ experience during a brief neurology clerkship. The hope is that use of such archival vignettes will help students hone their diagnostic and therapeutic skills in neurology regardless of their chosen specialty.

Learning management systems: technology to measure the medical knowledge competency of the ACGME.

We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course "Principles of Ambulatory Paediatrics", taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME). Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002. During this rotation residents were required to complete 4 modules in asthma, otitis media, gastroenteritis and fever, respectively. Each module was evaluated using a standard questionnaire. Completion rates for the required modules ranged from 64-72%. Residents in all 3 years of training showed improvement between the pre- and post-test scores for each module, except for postgraduate Year 2 residents in the asthma module. Most residents somewhat agreed, agreed or strongly agreed that the module components were useful and that the experience of completing the modules would improve their ability to take care of patients. The LMS WebCT is an innovative and adaptable approach for designing a web-based course for primary care education in paediatrics. The LMS addresses the educational needs of both a clinical division and a residency programme. The LMS also provides an information technology infrastructure to measure the medical knowledge competency required by the ACGME.

Emergency medicine training programs' educational requirements in the management of psychiatric emergencies: current perspective.

The purpose of this study was to determine the extent of training in clinical psychiatry that is provided and/or required by emergency medicine (EM) residency training programs and pediatric emergency medicine (PEM) subspecialty residency training programs. A questionnaire was mailed to 114 EM residency directors and to all 50 PEM fellowship directors. Each director was asked to indicate the amount of psychiatric training that was required of residents or fellows in his or her program. Details concerning the exact structure of psychiatric training were solicited from those offering such training. There was a 76% response rate (n = 88) among EM programs, and 76% (n = 59) of the respondents reported no formal training in the management of acute psychiatric emergencies. Only 14% (12 programs) provide a 1-month rotation in psychiatry. Of the 3-year programs, 14% (n = 11) offer 2-week psychiatric electives, and 9% (n = 8) offer some training. There was a 72% response rate among the PEM training programs. Only one of the 36 respondents provided a required 1-month rotation in psychiatry. Six programs stated the availability of a 1-month elective in psychiatry. Two programs reported 2 to 3 hours per year of core lecture time dedicated to psychiatric emergencies. Standardized psychiatric training is not required of most trainees in EM and PEM. Few (24%) training programs provide formal psychiatric training for their EM residents, and even fewer (< 3%) provide such training for their PEM fellows.

Palliative care education: an intervention to improve medical residents' knowledge and attitudes.

Medical care at the end of life remains poor. One approach to improving end-of-life care is through education of medical trainees. However, evidence regarding the structure of an ideal educational intervention is sparse. To test an innovative curriculum designed to improve medical resident knowledge and decrease anxiety surrounding end-of-life care. Quasiexperimental study of medical trainees in a large academic internal medicine residency. Attitudes and knowledge were measured at baseline and at completion of a 1-month clinical ward rotation for both control (n = 40) and intervention groups (n = 30) using the Collett-Lester Death Anxiety Scale (C-LDAS), the Semantic Differential Scale (SDS), and a 16-question knowledge-based test. Residents in the intervention group completed four 1-hour sessions focused on end-of-life issues. Baseline anxiety levels were high while knowledge scores were poor. Linear regression modeling demonstrated that pretest scores were the strongest predictor of post-test scores for all three measures. Additional significant predictors for the knowledge test were prior palliative care experience and year of training (p = 0.02), while prior palliative care experience alone contributed to the SDS model (p = 0.06). No significant improvements on the SDS, C-LDAS, or knowledge test occurred after the curriculum intervention. Our classroom intervention had no significant effect on residents' attitudes towards or knowledge of end-of-life care. The fact that prior palliative care experience affects baseline scores provides a strong argument for continued research for an effective curriculum for end-of-life education, perhaps focusing on clinical rather than didactic experiences in palliative care.