Clinical Education Research Articles

Description of a Longitudinal Interprofessional Education Plan and Outcomes From an Inaugural Student Cohort

ObjectiveTo describe a longitudinal interprofessional education (IPE) plan at 1 school of pharmacy including inaugural student cohort outcomes. MethodsStandards 2016 prompted the creation of an IPE task force at the University of Wisconsin–Madison School of Pharmacy to develop and implement an IPE plan consisting of outcome-based goals, a deliberate design, and a formalized assessment strategy (an approach that inspired national consensus guidance from the Health Professions Accreditors Collaborative). Beginning with the 2022 graduating class, required interprofessional learning activities were embedded longitudinally across a 4-year Doctor of Pharmacy program and included classroom-, simulation-, and clinical-based IPE activities. Student learning outcomes, focused on attitudes, skills, and behaviors, were assessed longitudinally using 3 self-reported, validated measures allowing before and after comparisons: Student Perceptions of Interprofessional Clinical Education–Revised, Version 2, Interprofessional Education Collaborative Competency Self-Assessment Tool, Version 3, and Interprofessional Collaborative Competencies Attainment Survey–Revised, coupled with the Individual Teamwork Observation and Feedback Tool. ResultsEnd point Student Perceptions of Interprofessional Clinical Education–Revised, Version 2 and Interprofessional Education Collaborative Competency Self-Assessment Tool, Version 3 average scores were in the agree to strongly agree range with statistically significant before and after change in 80% (4 of 5) of subscales. Students’ attainment and demonstration of positive teamwork behaviors were evidenced by statistically significant before and after changes in advanced pharmacy practice experience student Interprofessional Collaborative Competencies Attainment Survey–Revised scores and universal satisfactory ratings of advanced pharmacy practice experience students on the Individual Teamwork Observation and Feedback Tool. ConclusionA developmentally progressive, longitudinal IPE plan was implemented into a 4-year Doctor of Pharmacy program. Inaugural student cohort assessment results documented students were prepared for interprofessional practice upon graduation.

The Application of Case-Based Learning (CBL) Combined with PDCA Cycle in the Clinical Teaching Practice of Breast Ultrasound in Standardized Residency Training

Background: The integration of case-based learning (CBL) with the plan-do-check-act (PDCA) cycle has potential benefits for clinical education, yet its efficacy in ultrasound residency training, particularly for breast ultrasound, requires evaluation. Aim: This study aimed to assess the impact of a combined CBL and PDCA cycle teaching model on the clinical thinking and skills of ultrasound residents compared to traditional teaching methods. Methods: A comparative study was conducted at Sichuan Provincial People’s Hospital’s ultrasound medicine base, from August 2020 to June 2023, focusing on residents in training. Sixty-one trainees were randomly divided into two groups: a joint group (n = 31) taught using a PDCA cycle-based model integrated with CBL and a traditional group (n = 30) taught with conventional methods. Both groups underwent a 20-hour course and were subsequently evaluated on theoretical knowledge, clinical thinking, and skills. Comparative statistical analysis was performed to evaluate the performance differences between the two groups. Results: The joint group demonstrated significantly better clinical thinking and skills operation than the traditional group (P < 0.05). No significant difference was observed between the groups regarding theoretical knowledge (P > 0.05). Conclusions: The combined CBL-PDCA cycle teaching mode significantly enhances the clinical thinking abilities and operational skills of residents in breast ultrasound training. This innovative approach shows promise as an effective educational strategy to foster intrinsic motivation and higher order learning capabilities among ultrasound residents.

Reaching the unreachable through action research? Thomas Mathiesen and the Nordic socio-legal tradition

Thomas Mathiesen has been a source of inspiration for research in critical sociology, criminology, and the sociology of law for many decades. Mathiesen’s impact extends far beyond the academic realm, as his action research lives on. This intervention discusses the ongoing influence of Mathiesen’s action research approach, which integrates research, education, and societal impact. This is illustrated through an action research project we conducted in Denmark’s largest marginalised living area, where over 1,000 public housing units are being demolished, affecting approximately 2,500 residents. In the project, we experimented with different outreach legal aid approaches, considering our own positionalities, to gain knowledge about how to establish a legal aid infrastructure that could reach the unreachable. An ethical dilemma we faced was how we could engage with the people without inadvertently naming issues, particularly legal problems, of which they might not be aware. If the residents were unaware of these issues or did not consider them important, could we then inadvertently create and juridify new problems for them? Moreover, this intervention discusses how, in alignment with Mathiesen, we combined legal aid with legal clinical education, that is, training law students to become legal aid workers. We conclude that Mathiesen’s approach remains relevant, and by integrating his action research with decolonial thoughts, new insights may emerge to reach the seemingly unreachable.

Building patient safety culture by using interprofessional simulation with nursing, paramedic and emergency telecommunication students: A mixed-methods research study

AimThe aim of this study was to investigate student attitudes toward interprofessional education and collaborative practice and their perceptions of simulation design elements after participating in an interprofessional simulation educational activity. BackgroundPatient safety continues to be an international healthcare priority. However, critical incidents to patients continue to persist due to poor communication between professionals and poor teamwork. DesignA mixed methods design. MethodThe study sample consisted of Bachelor of Nursing (n=81), Paramedic (n=38) and Emergency Telecommunication (n=11) students randomized into interprofessional groups. Following the interprofessional learning experience, students completed two standardized self-reporting instruments, Students Perceptions of Interprofessional Clinical Education, National League for Nursing Simulation Design Scale and open-ended questions of their perceptions on teamwork and collaboration, communication skills, transfer of care and patient safety. ResultsStudents in each program reported high scores for attitudes toward the importance of teamwork and collaborative practice. There were significant differences in scores between programs for the ranking factors ‘Teamwork and Team-Based Practice’ (BN=4.74SD 0.72, PM=4.66SD 0.81, ET=4.95SD 0.15 *; p = 0.00005) and ‘Roles & Responsibilities’ (BN=3.78SD 1.12, PM=3.55SD 0.92, ET=4.67SD 0.85*; p= 0.012). Themes included: communication and collaboration in teamwork; roles, responsibilities and leadership; patient-centred care and safety; and emotional dynamics and professional growth. ConclusionAn interprofessional simulation is an effective strategy to practice teamwork and collaboration and communication skills during transfer of care. Ensuring earlier education of roles and responsibilities during transfer of care needs review as do strategies for structured handover communication tools.

Comparative analysis of Physician Assistant/Associate National Certifying Examination (PANCE) performance trends: pre and during COVID-19 era

BackgroundCOVID-19 significantly impacted physician assistant/associate (PA) education programs. Most programs transitioned didactic and clinical education from in-person to remote, and clinical training opportunities diminished. Graduates of accredited PA programs take the Physician Assistant National Certifying Examination (PANCE), a five-hour exam with 300 multiple-choice questions, and must attain or exceed the scaled passing score of 350 (range: 200–800). We examined first-time examinees’ trends in PANCE scores and passing rates three years prior to the pandemic and three years during.MethodsWe analyzed data (N = 59,459) from the National Commission on Certification of Physician Assistants. The two primary outcomes were PANCE scores and pass rates. The main exposure was the timeframe: three years pre-pandemic (2017–2019) and three years during the pandemic (2020–2022). The 2017–2018 scores were equated to the new passing standard implemented in 2019. Covariates included age, gender, years the PA program has been accredited, program region, and rural-urban setting. Analyses consisted of descriptive, bivariate, and multivariate statistics.ResultsThe mean PANCE score and pass rate during the six-year study period were 463 and 93%, respectively. In unadjusted analyses comparing each year individually, mean PANCE score was highest in 2020 and lowest in 2022 than in all other years except for 2017. When comparing each pandemic year to the pooled three pre-pandemic years and adjusting for test-taker and PA program covariates, examinees scored significantly higher in 2020; there was no difference in 2021, and they scored lower in 2022. When controlling for covariates, examinees had 1.24 higher odds of failing in 2022 compared to the pooled pre-pandemic period.ConclusionFindings suggest that PANCE scores and pass rates were impacted during the third year of the pandemic. PANCE assesses if examinees have the essential clinical knowledge to enter the PA profession. It is crucial to determine whether the pandemic affected PANCE scores and pass rates to ensure PAs provide safe and high-quality patient care.

Dapagliflozin-associated euglycemic diabetic ketoacidosis in 66-year-old with type 2 Diabetes: A clinical case report

Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication of type 2 diabetes, often associated with the use of SGLT2 inhibitors. This case report describes an episode of EDKA in a 66-year-old male with a long history of type 2 diabetes and multiple comorbidities, who developed this complication following the introduction of dapagliflozin. Although his blood glucose levels remained within normal limits, laboratory tests revealed elevated ketonemia and severe metabolic acidosis. The patient was successfully treated with intravenous hydration and insulin therapy, leading to a rapid improvement in his clinical condition. This case underscores the importance of clinical vigilance and patient education for those treated with SGLT2 inhibitors to prevent and effectively manage this potentially life-threatening complication.

The COVID-19 experience through the lens of disability Twitter: A qualitative analysis.

The societal response and constraints of the COVID-19 pandemic reinforced ableism for disabled people who were yet again treated as an afterthought in society. Systemic ableism impacted their well-being, access, and ability to be active members of their community. Disabled experiences and voices must be heard and amplified to improve preparedness and address ableism. Disability Twitter is one avenue where the disability community can collectively listen and support one another. These voices can and should be used to influence policy and practice. This study used Disability Twitter to represent and honor the experiences of the disability community, using the COVID-19 pandemic as a moment in time. Qualitative thematic analysis of U.S.-based Twitter posts was conducted using retrospective social media posts. A total of 238 initial tweets from January 1, 2020 and September 30, 2022 were analyzed by the research team. Five themes were observed including ableism, devaluation, worthiness, act of reclaiming, and emotion. Disabled people reported instances of ableism, devaluation, and victimization by individuals, systems, and government entities throughout the pandemic. Disabled individuals utilized Twitter to share their collective experiences, urging society to address and respond to the needs of the disability community. Using social media to center the perspectives of the disability community can invoke system-wide change and inform policies. Implications for combating systemic ableism and promoting allyship for clinical professionals, research scholars, and educators are provided. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analyzing the Educational Needs of Dental Hygiene Students Using the Borich Needs Assessment and Locus for Focus Models

Objective: This study aimed to develop a standard for a practice-based curriculum that reflects the needs of dental hygiene students’ clinical practice education and to provide basic data that can contribute to improving dental hygienists’ competence in clinical practice. Methods: A survey of 132 dental hygiene students from selected universities was conducted. The Borich Needs Assessment model and The Locus for Focus models were used to evaluate the students’ educational needs for clinical practice content. Results: The highest level of present educational needs was for ‘fluoride application,’ while the greatest requirement was for ‘preparing surgical dental treatment’. Using The Locus for Focus model, 33 items in the first quadrant were identified as common to the Borich Needs Assessment priorities. These items include ‘dental insurance claims’, ‘patient reception’, ‘dental materials counseling’, ‘making a temporary crown’, ‘setting a temporary crown’, ‘document management’ and ‘prepare of dental emergencies’. Conclusions: The analysis of the clinical practice needs of dental hygiene students identified the needs for practice-oriented education. These findings suggest that future curriculum revisions should reflect not only the needs of students, but also the perspectives of educators and clinical dental hygienists.

Nursing Principles Practice Basic Competencies Scale – Turkish Adaptation Study

Objective: The main objectives of clinical education in nursing education are to develop the student’s competences in cognitive, affective and psychomotor areas. Reliable measurement tools are needed for the evaluation of these competences that begin to be gained with the first clinical practice. This methodological study investigated the cultural and Turkish validity of the Core Competence in Basic Nursing Practice Scale (CCFNPS) for undergraduate nursing students. Methods: A methodological research has been carried out on the cultural validation and adaptation of the scale. The construct’s validity was examined using both exploratory and confirmatory factor analysis in a sample of 466 students. The scale’s internal consistency reliability was evaluated using Cronbach’s alpha. Test-retest reliability was assessed using a dependent sample t-test and intraclass correlation with a sample of 30 students. Results: The scale’s content validity index was 0.98. The results of exploratory factor analysis revealed a five-factor structure similar to the original scale, the variance explained was 69.62%, but four items were removed from the scale due to low factor loading. Confirmatory factor analysis results (fit indices values) applied to the twenty – one items and five sub-dimensional structure were found to be acceptable. Scale Cronbach’s alpha values were above 0.70. Conclusion: The 21-item Turkish version of CCFNPS was found to be a valid and reliable scale for measuring the competencies acquired by students after their first clinical training.

The Impact of the Clinical Pharmacist-Led Diabetes Education on the Knowledge and Attitude of Individuals with Type II Diabetes Mellitus: An Interventional Study.

Diabetes mellitus is a complex condition to manage. Patients with a greater understanding and knowledge of their condition might achieve better glycemic control than others. This study aimed to evaluate the impact of clinical pharmacist-led diabetes education on the knowledge and attitude of individuals with type II diabetes mellitus (T2DM). This study was a quasi-experimental study which was conducted at a diabetes clinic in Khartoum, Sudan. The study population was adult individuals with T2DM who attended the diabetes clinic. The estimated sample size was 182 participants. The participants were selected randomly by a simple random sampling method. The knowledge and attitudes of the participants were assessed at baseline and at the end of the study after 12 months. The intervention was carried out through educational materials about diabetes and medications for its treatment. The majority of the participants were females. The mean age was 54.5 (±10) years. Most participants had a family history of diabetes (69.2%). The mean knowledge score after the intervention was increased by 1.4 (±0.1) from baseline, p value (<0.001), while the mean attitude score was increased by 1.7 (±0.2) from baseline, p value (<0.001). At baseline, 14.8% of the participants had a high level of knowledge and 18.7% had a negative attitude, while after intervention for 12 months, 28.5% of them had a high level of knowledge and 16.8% had a negative attitude (p values < 0.001, 0.032, respectively). The knowledge of and attitudes towards diabetes differed significantly as a result of the educational program provided by the clinical pharmacist.

Advancing Specialist Geriatric Medicine Training: A Successful Introduction to Simulation-Based Training

Abstract Background Simulation-based education (SBE) has been adopted by various specialties and is used to complement other aspects of education. Geriatric medicine is a diverse specialty, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBE the ideal vehicle to train geriatric medicine trainees. SBE is currently not a formal component of geriatric medicine training in Ireland and trainees experience varying levels of exposure to SBE. To address this, WICOPSIM in collaboration with the Royal College of Physicians (RCPI) facilitated a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBE. Methods A faculty consisting of RCPI Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians coordinated the event. All geriatric medicine trainees were invited to a one-day SBE event hosted by WICOPSIM. Lectures on simulation theory and application preceded a simulation scenario demonstration focusing on the interdisciplinary management of a patient whose capacity was in question; followed by a SBE participant workshop. Results Fifty-two trainees attended the event. Forty-five trainees completed the post-event survey. 98% (n=44) were satisfied with the variety of topics presented and felt more prepared to design and run a scenario. The simulation demonstration, debrief and design workshop met 100% trainees’ expectations. All trainees indicated that SBE should be a routine element of geriatric medicine training. 69% (n=31) intend to run SBE within their own department in the future. Conclusion This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBE. SBE offers trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging scenarios, in a protected environment. The positive feedback generated suggests SBE is a useful tool to enhance the specialist geriatric medicine training experience and warrants further exploration.

Competencies Required By All Hospital Doctors Caring for Older Adults: A Group Concept Mapping Study

Abstract Background The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To ensure the provision of adequate healthcare, it is imperative that that all hospital doctors are trained in the minimum geriatric competencies. Allowing for the broad, complex, and multidisciplinary nature of geriatric medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults. Methods GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults. Results Forty-eight participants completed the brainstorming stage, generating eighty-eight statements, and twenty-two participants took part in the subsequent sorting stage. Participants included hospital doctors, general practitioners, allied health professionals and patient advocacy groups. Nine competency domains were identified as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, ethical and legal matters relating to older adults, recognition and management of delirium and medication management. Conclusion The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.

Exploring the role of healthcare partners in referrals to a community-based exercise program with a healthcare-community partnership designed for people with balance and mobility limitations

Purpose To explore how healthcare partners in community-based exercise programs for people with balance and mobility limitations perceive and enact referral in the context of their role. Materials and methods We conducted a descriptive, qualitative study involving semi-structured interviews and reflexive thematic analysis. Results Twelve healthcare partners from the Together In Movement and Exercise (TIMETM) program completed interviews. Seven (58%) participants were clinicians and 5 (42%) held non-clinical roles. The most common professional background of participants was physical therapy (n = 9, 75%). Clinicians made direct referrals while non-clinical participants facilitated referral by promoting the program. The main theme was healthcare partners perceive their role in referrals as secondary to their role as educators and trainers. Subthemes were: (1) healthcare partners fulfill educator and trainer roles when conducting formal training of instructors, educating instructors during program visits, and fielding questions; (2) almost all healthcare partners facilitate referral by sharing program information formally and informally; and (3) healthcare partners in clinical practice make direct referrals depending on the clientele. Conclusions Healthcare partners perceive their roles as educators and trainers as taking precedence over their role in referrals. Findings can be used to guide selection and training of healthcare partners, design of clinical education programs, and research on competencies.

Strategies to improve the implementation of preventive care in primary care: a systematic review and meta-analysis

BackgroundAction on smoking, obesity, excess alcohol, and physical inactivity in primary care is effective and cost-effective, but implementation is low. The aim was to examine the effectiveness of strategies to increase the implementation of preventive healthcare in primary care.MethodsCINAHL, CENTRAL, The Cochrane Database of Systematic Reviews, Dissertations & Theses – Global, Embase, Europe PMC, MEDLINE and PsycINFO were searched from inception through 5 October 2023 with no date of publication or language limits. Randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies comparing implementation strategies (team changes; changes to the electronic patient registry; facilitated relay of information; continuous quality improvement; clinician education; clinical reminders; financial incentives or multicomponent interventions) to usual care were included. Two reviewers screened studies, extracted data, and assessed bias with an adapted Cochrane risk of bias tool for Effective Practice and Organisation of Care reviews. Meta-analysis was conducted with random-effects models. Narrative synthesis was conducted where meta-analysis was not possible. Outcome measures included process and behavioural outcomes at the closest point to 12 months for each implementation strategy.ResultsEighty-five studies were included comprising of 4,210,946 participants from 3713 clusters in 71 cluster trials, 6748 participants in 5 randomised trials, 5,966,552 participants in 8 interrupted time series, and 176,061 participants in 1 controlled before after study. There was evidence that clinical reminders (OR 3.46; 95% CI 1.72–6.96; I2 = 89.4%), clinician education (OR 1.89; 95% CI 1.46–2.46; I2 = 80.6%), facilitated relay of information (OR 1.95, 95% CI 1.10–3.46, I2 = 88.2%), and multicomponent interventions (OR 3.10; 95% CI 1.60–5.99, I2 = 96.1%) increased processes of care. Multicomponent intervention results were robust to sensitivity analysis. There was no evidence that other implementation strategies affected processes of care or that any of the implementation strategies improved behavioural outcomes. No studies reported on interventions specifically designed for remote consultations. Limitations included high statistical heterogeneity and many studies did not account for clustering.ConclusionsMulticomponent interventions may be the most effective implementation strategy. There was no evidence that implementation interventions improved behavioural outcomes.Trial registrationPROSPERO CRD42022350912.

Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal. To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care. Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles. Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes. Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.

Who you are and who you want to be: a pilot study of dental hygiene students' professional identity formation

BackgroundDental hygienists play a crucial role in providing successful community-based healthcare for patients. They should perform expected roles to address various tasks, in response to changing social contexts and needs. The value created by the role of a dental hygienist closely relates to job satisfaction, which is formed through daily clinical experiences, and in the process of professional identity formation, learners must internalise a value system. This study examined how dental hygiene students developed their professional identities during their undergraduate education.MethodsThis study adopted a case study approach based on an interpretivist paradigm. Ten dental hygiene students in their final year were selected, and semi-structured interviews were conducted regarding changes in their views on dental hygienists and their identities as health professionals. The data were analysed using a thematic analysis approach to identify the components of their professional identities and the factors influencing identity formation.ResultsStudents pre-professional identities were transformed into inter-professional collaborators with a more patient-centric and generalist perspective. The following three aspects of professional identity were identified: their own roles in promoting oral and general health, broadening the perspectives on professional competencies of dental hygienists, and the context of inter-professional collaborative practice. Additionally, this study identified some key factors influencing their identity formation, namely role models, clinical experiences, health care system, and social relationships with others. Among these factors, role models and clinical experiences were the most influential.ConclusionsThis study suggests that recognition of professional roles during preclinical education, and collaborative opportunities in clinical education are necessary to promote professional identity formation. Such learning opportunities enable students to reflect on the kind of dental hygienist they want to become. Moreover, for the students to continuously pursue their profession with a sense of fulfilment, educators need to gain a deeper understanding of the challenges the students would encounter as they transition from their undergraduate degrees to employment. This understanding is essential for developing and supporting communities where dental hygienists connect, help, and learn from each other.

Qualitative perspectives of Medicaid-insured patients on ambulatory care at an academic medical center: challenges and opportunities

BackgroundAmbulatory access to academic medical centers (AMCs) for patients insured with Medi-Cal (i.e., Medicaid in California) is understudied, particularly among the 85% of beneficiaries enrolled in managed care plans. As more AMCs develop partnerships with these plans, data on patient experiences of access to care and quality are needed to guide patient-centered improvements in care delivery.MethodsThe authors conducted semi-structured, qualitative interviews with Medi-Cal-insured patients with initial visits at a large, urban AMC during 2022. Participant recruitment was informed by a database of ambulatory Medi-Cal encounters. The interview guide covered Medi-Cal enrollment, scheduling, and visit experience. Interviews were transcribed and inductively coded, then organized into themes across four domains: access, affordability, patient-provider interactions, and continuity.ResultsTwenty participant interviews were completed (55% female, 85% English speaking, 80% self-identified minority or “other” race, and 30% Hispanic or Latino) with primary and/or specialty care visits. Within the access domain, participants reported delays with Medi-Cal enrollment and access to specialist care or testing, though appointment scheduling was reported to be easy. Affordability concerns included out-of-pocket medical and parking costs, and missed income when patients or families skipped work to facilitate care coordination. Participants considered clear, bilateral communication with providers fundamental to positive patient-provider interactions. Some participants perceived discrimination by providers based on their insurance status. Participants valued continuity, but experienced frustration arising from frequent and unexpected health plan changes that disrupted care with their established AMC providers.ConclusionsThe missions of AMCs typically focus on clinical care, education, research, and equity. However, reports from Medi-Cal insured patients receiving care at AMCs highlight their stress and confusion related to inconsistent provider access, uncompensated costs, variability in perceptions of quality, and fragmented care. Recommendations based upon patient-reported concerns suggest opportunities for AMC health system-level improvements that are compatible with AMC missions.

Assessment of ChatGPT's Compliance with ESC-Acute Coronary Syndrome Management Guidelines at 30-Day Intervals.

Background: Despite ongoing advancements in healthcare, acute coronary syndromes (ACS) remain a leading cause of morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines have introduced significant improvements in ACS management. Concurrently, artificial intelligence (AI), particularly models like ChatGPT, is showing promise in supporting clinical decision-making and education. Methods: This study evaluates the performance of ChatGPT-v4 in adhering to ESC guidelines for ACS management over a 30-day interval. Based on ESC guidelines, a dataset of 100 questions was used to assess ChatGPT's accuracy and consistency. The questions were divided into binary (true/false) and multiple-choice formats. The AI's responses were initially evaluated and then re-evaluated after 30 days, using accuracy and consistency as primary metrics. Results: ChatGPT's accuracy in answering ACS-related binary and multiple-choice questions was evaluated at baseline and after 30 days. For binary questions, accuracy was 84% initially and 86% after 30 days, with no significant change (p = 0.564). Cohen's Kappa was 0.94, indicating excellent agreement. Multiple-choice question accuracy was 80% initially, improving to 84% after 30 days, also without significant change (p = 0.527). Cohen's Kappa was 0.93, reflecting similarly high consistency. These results suggest stable AI performance with minor fluctuations. Conclusions: Despite variations in performance on binary and multiple-choice questions, ChatGPT shows significant promise as a clinical support tool in ACS management. However, it is crucial to consider limitations such as fluctuations and hallucinations, which could lead to severe issues in clinical applications.

Molecular detection of Ehrlichia spp., Anaplasma spp., and Bartonella spp. in dogs treated at a veterinary teaching clinic in Peru

In recent years, vector-borne diseases have become widespread throughout the world and affect the health of humans and domestic animals. These diseases spread to areas where their primary vectors, fleas and ticks, thrive, particularly in tropical and subtropical climate regions, providing ideal conditions for their proliferation. The growing closeness between people and their pets increases the likelihood of bites from these ectoparasites, which represents a latent zoonotic risk. Therefore, the objective of the study was to determine the presence of Anaplasma spp., Ehrlichia spp., and Bartonella spp. in dogs treated at the Small Animal Clinic of the Faculty of Veterinary Medicine of the Universidad Nacional Mayor de San Marcos, located in Lima, Peru. Blood samples from 214 dogs were molecularly analyzed for hemopathogen detection. The results revealed prevalences of 2.6 % (6/214) for Anaplasma platys, 5.14 % (11/214) for Ehrlichia canis, and 0.46 % (1/214) for Bartonella rochalimae. No statistically significant relationship was found between the animal infection and the age, sex, breed, presence of fleas (Ctenocephalides felis) and ticks (Rhipicephalus sanguineus), and locality. This study reported molecularly for the first time the presence of A. platys, E. canis, and B. rochalimae in dogs from Lima city, and demonstrates the occurrence of zoonotic pathogens in pets treated at the veterinary clinic.

Evaluation of Clinical Education Based on Cognitive Apprenticeship Model Using Maastricht Clinical Education Questionnaire

Introduction: One of the main aspects of medical students is clinical education. The cognitive apprenticeship model is one of the principles of clinical education and contains six dimensions, including modeling, coaching, scaffolding, articulation, reflection, and exploration. This research aimed to evaluate the clinical education at Kerman University of Medical Sciences based on the cognitive apprenticeship model in 2021. Method: In this descriptive-analytical cross-sectional research, the Maastricht Clinical Education Questionnaire was separated among 150 students, and with a response rate of 74%, 112 of them completed this. Results: In the evaluation of the clinical education at Kerman University of Medical Sciences, the score of the articulation domain was higher than others, and the lowest score was given to the reflection domain. Clinical education in the internal medicine department was the most consistent with the cognitive apprenticeship model. Conclusion: Identifying the strengths and weaknesses of clinical education is the first step toward improving the quality of medical education. In the subsequent steps, the practitioners and planners of the faculty member empowerment programs should design, implement, and evaluate educational empowerment programs for clinical faculty members to improve their academic skills in the clinical education environment.