Health Care Disciplines Research Articles

Coping with COVID: Preparing prescribers during the pandemic.

In response to the COVID‐19 pandemic, Health Education England (HEE) and the University of Birmingham provided National Health Service (NHS) staff free access to SCRIPT, a national eLearning programme for safer prescribing and therapeutics. The eLearning was particularly for those returning to work or being redeployed. In the year March 2020‐21, 3412 users registered to access portfolios and opened an aggregate of 17 198 modules. Each user completed a median of 2 (range 1‐50, interquartile range [IQR] 1‐7) assessed learning modules. Marks improved from pre‐test to post‐test by a median of 2 (IQR 0‐3) marks out of 10. The most frequently selected modules were Adherence and Concordance (1109 users), Fluids (981 users) and Diabetic Emergencies (818 users). A total of 878 users accessed the unassessed COVID‐19 module. The SCRIPT modules provided standardised education in core principles relating to prescribing and therapeutics, and were used by professionals from many healthcare disciplines.

Virginia’s Response to the Nursing Home COVID Action Network

The Virginia Geriatric Education Center’s GWEP recruited 195 of Virginia's 273 eligible nursing homes, using two Project ECHO Nursing Home Training Centers located at George Mason University and Virginia Commonwealth University. These sessions promoted collaboration, allowed for sharing of successes and challenges, and nurtured quality improvement projects. Our next steps are to survey Virginia’s nursing homes to see if they are interested in future ECHO sessions with other topics. We plan to share these results with the Institute for Healthcare Improvement so that we may be able to continue to enhance this national network of Training Centers with faculty and staffing dedicated to quality assurance and performance improvement. The program has initiated new collaborations with nursing homes across many healthcare disciplines, strengthened connections between nursing homes and research institutions, and will help foster innovative ways to collaborate in this post-pandemic virtually connected world.

Aging With Intellectual and Developmental Disabilities: When Dementia Is Diagnosed or Suspected

Individuals with lifelong intellectual and developmental disabilities (IDD) have unique needs associated with aging that pose challenges for them and their families. In particular, an increased likelihood for early onset Alzheimer’s disease is a major concern that can place individuals at risk for a host of biomedical, psychological, and social challenges. Faced with providers not trained in how to properly screen for, diagnose, and treat conditions, individuals and families are often left with inadequate care, services, and support. To address these concerns, education for professionals is essential in providing accurate information based on clinical best practices. This symposium presents an innovative and interprofessional model developed by a partnership of geriatrics and IDD educational and service organizations based on Project ECHO (Extension for Community Healthcare Outcomes) methodology. A virtual community is created in which participants both teach and learn from each other through a combination of didactic and case presentations. The first paper describes the ECHO model, including the development of the hub and spoke structure, recruitment of providers, and collaborative and multidisciplinary process of curriculum development. The second paper explores educational experiences of participating spoke agencies in the program, including professionals’ and clients’ outcomes. The third paper presents the implications of creating a foundation based on interprofessional education and networking principles to bridge the gap between health and social care disciplines and parallel service systems. The final paper provides recommendations and implications for developing and refining methods to address the need for provider education in this rapidly expanding field.

A multidisciplinary, cross-sectional survey of burnout and wellbeing in emergency department staff during COVID-19

BackgroundEmergency department (ED) staff are at-risk of burnout, poor wellbeing and increased stress that can impact patient satisfaction, staff morale and retention. The aim of this survey was to determine level of burnout, stress and satisfaction with current employment role in ED during COVID-19. MethodsA multisite cross-sectional survey captured ED employment data, wellbeing, burnout (Maslach Burnout Inventory), stress (Health Professions Stress Inventory), work environment (WES-10) and Caring for COVID-19 Patients questions. ResultsThe response rate of 44.2% (n = 177) represented all healthcare disciplines. Only 58.8% (n = 104) of participants were happy in their role, satisfaction was low, burnout was high (M 71.0, SD 17.1) as was level of stress (M 90.6, SD 16.5). Nurses and allied health staff were more stressed than their medical or support staff colleagues. Participants perceived discriminatory behaviours from friends and family in caring for suspected or infected COVID-19 patients. ConclusionsED staff are a vulnerable group. Programmes to promote wellbeing, personal resilience, and self-care together with personal and professional growth are needed to build individual capability and a culture of organisational resilience, particularly in the context of the COVID pandemic.

Interprofessional mock code simulation promotes collaboration and competency in Parkinson's medication safety during transition in care

An interprofessional mock code simulation was designed to educate students from four healthcare disciplines on the care of a patient with Parkinson's disease (PD) during a care transition. This interprofessional education initiative facilitated students learning about, from, and with each other. The simulation consisted of an unfolding patient with Parkinson's disease (PD) that involved an incomplete medication reconciliation and an omission of time-sensitive PD medication, resulting in a full code. The simulation explored quality improvement strategies for safe and timely medication administration and reconciliation during a care transition for a patient with PD. The simulation was conducted in the Learning Resource Simulation Center with small groups of students from two separate institutions and four separate schools or college programs rotating throughout the semester. The student participants consisted of the following: Baccalaureate Degree Senior Nursing Students; Master's level Senior Nurse Anesthesia Students; Fourth-Year Doctor of Osteopathic Medicine Students; and Fourth-Year Doctor of Psychology Students. The objectives of the interprofessional mock code simulation were as follows: 1) learners shall understand the roles and responsibilities of members of a healthcare team by participating in an interprofessional simulation of a patient with Parkinson's disease during a mock code scenario; 2) learners shall recognize the harm that occurs from incomplete medication reconciliation specific to Parkinson's disease during care transitions such as disorientation, garbled speech, severely limited breathing capacity and even death; and 3) learners from four different healthcare disciplines will evaluate their comfort and competence specific to working as part of an interprofessional healthcare team during a mock code simulation. The simulation demonstrated an increase in knowledge among all the interprofessional healthcare team members regarding PD medication safety. This PD unfolding case study simulation training also helped students and future professionals feel comfortable and competent while working together during a patient code situation in the acute care setting. This simulation holds great potential for dissemination among all faculty disciplines to improve the quality and safety of the PD population during care transitions. A complete copy of the IPE simulation is available upon request from the primary author.

President’s Message

As we close out another unprecedented year of a global pandemic and say goodbye to 2021, I am tremendously grateful and humbled for the support of my peers, friends, and family. Although 2021 was another year of restrictions and some turmoil personally, professionally, and politically, there is still so much to be grateful for.I am grateful for my colleagues in various health care settings and disciplines around the globe. All deserve to be recognized for sacrifices and hard work in their communities. I am amazed at what we have achieved as vascular access specialists and our continued commitment to patient safety in the last year and, specifically, through the ups and downs during the global pandemic.As I finish up my term as AVA President, I am impressed and proud of what our association has achieved this year under extraordinary circumstances. I celebrate these achievements with you because, like in health care, our success is because of a team effort.In brief; for more detailed info, please go to the AVA website at www.avainfo.org.And finally for 2021, I want to acknowledge the work and commitment of outgoing board members. They have graciously and tirelessly volunteered their time for many years on the board: Presidential Advisor: Lori Kaczmarek, MSN, RN, VABC™Secretary: Russell Nassof, JDDirector-at-Large: Monte Harvill, MDFirst and foremost, I hope we will be able to have a face-toface AVASM22 in Minneapolis from September 30 to October 3, 2022, at the Minneapolis Convention Center. (Premeeting sessions will be September 29). Stay tuned for the Call for Abstracts and detailed info on registration and accommodations.As I move into the Presidential Advisor role, I am honored to pass the baton to incoming President Tonja Stevens, RN, BSN, VA-BC™, who will no doubt successfully lead the board and association with her strong will and determination.Welcome to the rest of the members on the 2022 AVA Board of Directors: President-Elect: Tonya Heim, MHA, MSN, RN, NEABCSecretary: Michelle DeVries, MPH, CIC, VA-BC™Treasurer: Jon Bell, RN, MSN, VA-BC™Directors-At-Large:There is a lot of work to be done, and I know this group will be able to achieve great things.I want to give a special shout-out to the AVA Foundation (AVAF) and the Vascular Access Certification Corporation (VACC). These 2 partner organizations are very important as AVA strives to stay the course toward our AVA missionto lead health care by protecting patients and providers to improve lives with a vision of a world with safe vascular access.I am excited for the ongoing and future collaboration with AVAF President Amy Bardin-Spencer, EdD, MSc, RRT, VABC™, and incoming VACC President Leigh Ann Bowe Geddes, MSN, VA-BC™.Both leaders are longtime AVA members and are well known and highly respected in our specialty. I am confident we will benefit from their work to bridge gaps between our organizations and move forward as a dynamic team.We can’t deny that we have been challenged the last year or 2 like we have never been before with polarization and division that impact our daily life within our communities. But with this, I have come to appreciate even more the expertise and knowledge within our association and the open dialogue and discourse within our global network. It is our responsibility to promote and participate in the development and publication of experiences that ultimately lead to evidence-based practice, even when it means challenging the status quo as we strive to synthesize knowledge and information and make it relevant to our practice and lives. I am biased! Biased toward the belief that AVA can play a significant role in providing evidence-based, best practice, and improved education for clinicians and for patients.I will close out with a repeat and emphasis on my call to action to you, the AVA members and specialists in vascular access, from my very first message as president at the start of my term:Stay involved and let us know what AVA can do to improve and how to provide the best education, communication, and information.We can only improve, strengthen, and expand with the involvement of key stakeholders such as yourselves and, of course, all our industry partners.My first message was written in a time of uncertainty, and I assumed we would be long past the challenges of the pandemic. AVA is still a strong association today, in spite of the ongoing challenges and uncertain times. We are an association with members who are resilient, passionate, and nimble from all over the world. I write this as an international from Vancouver, Canada - I am a proud AVA member and thankful for the opportunity to lead as president this past year.Keep safe, well and healthy and SEE YOU ALL SOON!

SBIRT training: how do social work students compare to medical learners?

ABSTRACT Background: SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an effective early intervention approach for individuals with substance misuse. The purpose of this study was to determine if medical learners are more adept at learning a brief substance use intervention compared to non-medical learners (e.g., social work students). The dissemination of SBIRT training among many helping professions can increase service delivery for substance use problems. Methods: A total of 2,488 participants completed SBIRT training, representing 15 different disciplines and over 20 different institutions. General linear models and paired t-tests were used to investigate the effects of SBIRT training on changes in knowledge and attitude of alcohol and drug use and satisfaction. Results: There were no statistical differences in the change of satisfaction, knowledge, and attitude between medical and non-medical discipline participants. Both medical and non-medical participants had greater improvement in attitude and knowledge scores post-training. Similar improvements in attitude, knowledge, and satisfaction were observed in all the health-care discipline participants. Discussion: SBIRT skills may be transferable to disciplines including non-prescribing professionals (e.g., social work, nursing, physical therapy, rehabilitation science, and pharmacy). In an effort to expand treatment, health-care training institutions adopt SBIRT as a core competency for professional practice.

Integration of IoT and MLA In Prediction of Diabetes : An Overview

A Healthcare system that employs modern computer techniques is the most investigated area in Research. For many years, researchers in the disciplines of Healthcare have collaborated to improve such systems technologically. A number of Internet-based apps on diabetes management have been proposed as a result of rapid developments in wireless and web technology. According to a recent World Health Organization Survey the number of persons affected with diabetics has increased. Diabetes chronic symptoms are the most common Health Problems. Large volumes of medical data are being created. These patients' health data should be recorded and preserved so that continual monitoring and technology advancements can be used to interpret, learn, and anticipate. Internet of Things (IoT) is used to implement numerous applications. IoT can be used in numerous domains, like the health surveillance system of patients. Various successful machine learning methods can be used to forecast diabetes, allowing people to avoid it and receive treatment as soon as possible. Different machine learning classification algorithms for diabetes are investigated in depth in this work. Machine learning algorithms applied on the diabetes data set include K-Nearest Neighbor (KNN), Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), Naive Bayes (NB), and others.

The Critical Need for Advanced Training in Electronic Records Use: Implications for Clinical Practice, Education, and the Advancement of Athletic Training.

The effective use of electronic records (ie, electronic health records or electronic medical records) is essential to professional initiatives and the overall advancement of the athletic training profession. However, evidence suggests that comprehensive patient care documentation and widespread use of electronic records are still limited in athletic training. The lack of formal training and education for clinicians and students is often cited as a primary barrier to electronic record use. Other health care disciplines have used academic electronic health record (AEHR) systems to address these barriers with promising results. To identify common challenges associated with the effective use of electronic records in clinical practice, discuss how an AEHR system can address these challenges and encourage more effective use of electronic records, and describe strategies for deploying AEHRs in the athletic training profession. The AEHR is an electronic records system specifically designed for educational use to support simulation learning among all types of learners (eg, practicing clinicians, students). Mimicking the form and function of an electronic health record, the AEHR offers various educational tasks, including patient care documentation projects, critical reviews of standardized patient cases, and assessments of patient care data for quality improvement efforts. Recent evidence suggests that the use of an AEHR can improve knowledge and enhance skills. Specifically, AEHR use has been associated with enhanced attitudes toward electronic health record technology, increased informatics competencies, and improved documentation skills. Also, the use of an AEHR has been associated with improved critical thinking and decision-making skills. This tool appears to be valuable for health professions education, and athletic training stands to benefit from its use to better train and upskill clinicians and students alike for clinical practice. Although the implementation of an AEHR will require much time and large-scale coordinated efforts, it will be a worthy investment to address current challenges and advance the athletic training profession.

Commentary on Elbers et al. "Longitudinal outcome evaluations of IMPT programs".

"This journal recently published a paper by Elbers et al., entitled "Longitudinal outcome evaluations of interdisciplinary multimodal pain treatment programs for patients with chronic primary musculoskeletal pain: a systematic review and meta-analysis". It not only provides an evaluation of outcomes, but also a glimpse into the nature of these programs. Elbers and colleagues raise several issues of importance for clinicians, clinical researchers, and health service providers/funders.

Promoting Interprofessional Communication through Situation, Background, Assessment, and Recommendation (SBAR): An Educational Technique

Context The Board of Certification Standards of Professional Practice and the 2020 Curricular Content Standards indicate athletic trainers should establish working relationships with collaborating medical professionals and be able to communicate effectively. In addition, increased emphasis on interprofessional collaboration (IPC) in practice is apparent throughout health care professions and their educational programs. However, integrating both interprofessional communication and IPC within 1 learning opportunity can be difficult. Objective To share an educational approach aimed to enhance athletic training students' abilities and confidence in delivering patient information to physician assistant students via the situation, background, assessment, and recommendation (SBAR) technique. Background As part of the health care team, athletic trainers need to communicate with various providers while making clinically based decisions. Anecdotally, learners in their final year of health care education are not confident in their ability to make recommendations to other health care professionals. The SBAR communication strategy from the evidence-based framework TeamSTEPPS has become widely adopted in health care disciplines and may help to enhance confidence in communication. Description This learning activity enables athletic training students to use a patient case scenario to develop an SBAR for delivery via phone to a physician assistant studies student. This article describes the content, delivery methods, outcomes to date, and connection to the 2020 Curricular Content Standards. Clinical Advantage(s) This clinically relevant activity provides a low-stakes, real-life opportunity for students to practice communication skills, including the following: condensing the evaluation process, clinical decision-making skills, and the ability to make recommendations for a plan of care. Active participation in the communication process enhances reasoning skills needed for collaborative clinical decision making and the transfer of care, when applicable. Conclusion(s) Developing and implementing an interprofessional SBAR communication experience with 2 health care disciplines is an innovative strategy that bridges the gap between clinical education and actual patient care experiences while addressing curricular content needs.

Design and Evaluation of an Athletic Training Educational Escape Room

Context The educational escape room is an innovative teaching strategy, and the use of this technique is gaining popularity in some health care disciplines. It is believed to promote acquisition of knowledge and skills, increase motivation, and encourage engagement, critical thinking, collaboration, and problem-solving. Objective To describe the use of an innovative educational escape room in a master's-level athletic training course and to examine learning effectiveness and students' perceptions. Design Quasi-experimental. Setting A Commission on Accreditation of Athletic Training Education–accredited master's-level athletic training program. Patients or Other Participants A convenience sample of 14 students enrolled in a master's-level professional athletic training program participated. Intervention(s) Educational escape room. Main Outcome Measures(s) A paired-samples t test was used to determine differences between preactivity and postactivity knowledge-assessment scores. Measures of central tendency were used for survey questions related to student perceptions of the activity. Student perceptions were assessed after the intervention. Results All participants completed the preactivity and postactivity knowledge assessments. The difference in scores was found to be statistically significant (t13 = −4.502, P = .001), with a large effect size (Cohen d = 1.32). Participants thought the escape room was an effective way to improve their knowledge of course materials (mean ± SD = 5.0 ± 0.0) and encouraged them to apply course material in a new way (mean ± SD = 4.9 ± 0.27). Participants reported that they had fun (mean ± SD = 5.0 ± 0.0) and felt that the activity was immersive (mean ± SD = 5.0 ± 0.00). Qualitative elements from the postactivity survey corroborated the data. Conclusions The education escape room described in this study promoted learning while providing a fun and engaging learning experience with positive perceived value.

Use of vision-based augmented reality to improve student learning of the spine and spinal deformities. An exploratory study.

BackgroundKnowledge of anatomy and pathology of the spine together with spinal deformities is integral to several healthcare disciplines. This knowledge is crucial for graduates for assessment and management of patients with spinal problems. Physiotherapy students generally find it difficult to conceptualise the integrity of the structure and function of the spine that affects their acquisition of related physiotherapy skills.ObjectiveOur first objective was to introduce and evaluate the use of a Vision-Based Augmented Reality (VBAR) mobile application to teach students the anatomy and accessory movements of the spine. A further objective was to explore student experiences of and engagement with VBAR by conducting a post-lecture survey comparing VBAR to traditional teaching.MethodsThis post-intervention crossover design study included two groups: final year physiotherapy students (n = 74) and mean age of 23 (±1.8). The computing department at Teesside University developed the VBAR mobile application. Moreover, a survey adapted from a previously published article was disseminated to students to evaluate their level of understanding following the use of the VBAR application.ResultsThe results demonstrated that the median questionnaire scores in students’ perceived level of understanding for the VBAR group were significantly higher than for the traditional teaching group (p < 0.05).ConclusionThe results of this post-intervention survey suggest that the integration of VBAR learning activities results in gains relating to students’ understanding of spinal anatomy, function, pathology and deformities. These findings suggest that VBAR could be an additional teaching tool to support student learning.Clinical implicationsGreater understanding is expected to increase the quality of clinical practice.

Leveraging Podcasts to Introduce Medical Students to the Broader Community of Health Care Professionals.

IntroductionSafe, patient-centered, and cost-effective care requires effective collaboration within interprofessional teams. Education programs for health care professionals are often siloed, providing students with limited interprofessional education (IPE) opportunities to learn from, with, and about other professions. Podcasts offer a novel approach to facilitate IPE, allowing for asynchronous conversations with interprofessional colleagues.MethodsWe developed four podcasts with various health care professionals for 135 preclinical medical students preparing to transition into clinical rotations. The podcasts were coupled with an hour-long interactive session with the podcast interviewees conducted via videoconference. The curriculum explored the distinct education paths, roles, and responsibilities of various health care disciplines. Strategies for communicating effectively with and learning from interprofessional team members were emphasized.ResultsThere were 197 unique downloads of the podcasts, and 95 students attended the interactive session. Most students reported that the podcasts and follow-up live session enhanced their learning (100% and 98% of students who completed the postcurriculum survey, respectively). Responses to the postcurriculum survey revealed students learned strategies for engaging in productive interprofessional conversations, the importance of leveraging the distinct roles and responsibilities of diverse health professionals, the value of learning from other health professionals, and the use of respectful language.DiscussionThis IPE curriculum built around podcasts enhances medical student learning and represents an innovative approach to improving access to IPE in a virtual learning environment. This modality can be adapted to meet the needs of a wide spectrum of learners and can be coupled with in-person learning.

What do end-users want to know about managing the performance of healthcare delivery systems? Co-designing a context-specific and practice-relevant research agenda

BackgroundDespite increasing interest in joint research priority-setting, few studies engage end-user groups in setting research priorities at the intersection of the healthcare and management disciplines. With health systems increasingly establishing performance management programmes to account for and incentivize performance, it is important to conduct research that is actionable by the end-users involved with or impacted by these programmes. The aim of this study was to co-design a research agenda on healthcare performance management with and for end-users in a specific jurisdictional and policy context.MethodsWe undertook a rapid review of the literature on healthcare performance management (n = 115) and conducted end-user interviews (n = 156) that included a quantitative ranking exercise to prioritize five directions for future research. The quantitative rankings were analysed using four methods: mean, median, frequency ranked first or second, and frequency ranked fifth. The interview transcripts were coded inductively and analysed thematically to identify common patterns across participant responses.ResultsSeventy-three individual and group interviews were conducted with 156 end-users representing diverse end-user groups, including administrators, clinicians and patients, among others. End-user groups prioritized different research directions based on their experiences and information needs. Despite this variation, the research direction on motivating performance improvement had the highest overall mean ranking and was most often ranked first or second and least often ranked fifth. The research direction was modified based on end-user feedback to include an explicit behaviour change lens and stronger consideration for the influence of context.ConclusionsJoint research priority-setting resulted in a practice-driven research agenda capable of generating results to inform policy and management practice in healthcare as well as contribute to the literature. The results suggest that end-users are keen to open the “black box” of performance management to explore more nuanced questions beyond “does performance management work?” End-users want to know how, when and why performance management contributes to behaviour change (or fails to) among front-line care providers.

The extent of formal tobacco cessation training received by student health professionals and the prevalence of tobacco use among them: a cross-sectional study

Background: Advice from health care professionals (HCPs) is critical for tobacco prevention and cessation efforts. The academic curricula for health care professional students (HCS) lack comprehensive training in assisting patients in tobacco cessation. Tobacco use among HCP’s deters them from giving proper tobacco prevention and cessation guidance. The objective of this study was to determine the prevalence and determinants of tobacco consumption in third-year students of four health care disciplines (medical, dental, pharmacy, and nursing) and to assess their undergraduate education on tobacco control and cessation. Methods: A web-based survey (response rate 84.4%) employing the Global Health Professions Student Survey (GHPSS) questionnaire; n= 838; [20.89 (SD± 0.94) years] was conducted in Mysore, India. A descriptive, comparative and multivariate analysis was performed. Results: The number of students who received formal training in smoking cessation approaches was only 14.04%. In total, two-thirds of medical students, compared to 38.9% of dental, 29.7% of pharmacy, and 11.40 % of nursing students, learned “the reasons why people smoke” as a part of their formal training. However, only less than a quarter of the study population were aware of the role of antidepressants in nicotine cessation medications. The total prevalence of tobacco use was 28.9%. A total of 37.72% wanted to quit smoking, while a mere 1.2% had sought any professional help to do so. Conclusions: Tobacco use in HCS, apart from personal health risks to themselves, may potentially affect their future commitment to support patients in tobacco cessation. There is a need for further research into tobacco prevention and cessation programs tailored to the needs of student groups. There is a need for an updated curriculum for tobacco cessation strategies and more research into better cessation strategies.

Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics.

Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems.

Effects of COVID-19 on EMS Refresher Course Completion and Delivery

Introduction: The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period. Methods: The Commission on Accreditation for Prehospital Continuing Education (CAPCE) is the only national organization that accredits continuing education (CE) for paramedics and EMTs and currently has a database with over 14 million CE records. The total number of ER course completions each month in 2020 were compared to 2019 and 2018. We also compared the different educational format types: live in-person (LIP), asynchronous on-line distributive learning (DL), and virtual instructor lead training (VILT) synchronous DL courses. Data was analyzed using descriptive and two-way ANOVA statistics. Results: There were 1,922,783 ER course completions in 2020 versus 1,166,335 in 2019 and 1,074,636 in 2018, representing a 179% increase during the study period. Asynchronous DL course completions in 2020 were 1,830,513 EMS versus 1,078,580 in 2019 and 987,749 in 2018 a 185% increase over the three-year study period. Asynchronous DL monthly means by year was statistically significant, F(2, 99) = 95.632, p < .001. Mean monthly LIP and VLIT educational deliveries by year were not significantly different, p = .802, p = .754, respectively. Total LIP course completions in 2020 were 20,045 versus 51,552 in 2019 and 63,058 in 2018. In 2020 LIP courses made up only 1.0% (20,045/1,922,783) of all ER completions. This study was limited to only EMS professionals taking ER course completions in the CAPCE database. However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease. Conclusion: This large nationwide study of EMS profession has shown the trend toward DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.

Connecting the dots: Bridging virtual to in-person physical assessment

When restrictions imposed by COVID-19 prevented prelicensure nursing students from practicing skills in the simulation center, the faculty designed a plan to bridge the gap from virtual to in-person skill performance for physical assessments. The faculty anticipated an inadequacy of head-to-toe assessment skills related to the lack of face-to-face clinical. Therefore, the faculty used the Plan-Do-Study-Act model (Agency for Healthcare Research and Quality, 2020) for quality improvement to address the skill performance issue. The plan used colored adhesive "garage sale" dots to identify anatomical landmarks to help students with correct stethoscope placement during their first in-person simulation after a virtual semester. Pre- and post-tests were administered to assess confidence in assessment skills. Using this method on standardized patients in simulation, nursing students reported increased confidence in stethoscope placement. Students of all healthcare disciplines could benefit from the economical dotting process to learn correct stethoscope placement.

The extent of formal tobacco cessation training received by student health professionals and the prevalence of tobacco use among them: a cross-sectional study

Background: Advice from health care professionals (HCPs) is critical for tobacco prevention and cessation efforts. The academic curricula for health care professional students (HCS) lack comprehensive training in assisting patients in tobacco cessation. Tobacco use among HCP’s deters them from giving proper tobacco prevention and cessation guidance. The objective of this study was to determine the prevalence and determinants of tobacco consumption in third-year students of four health care disciplines (medical, dental, pharmacy, and nursing) and to assess their undergraduate education on tobacco control and cessation. Methods: A web-based survey (response rate 84.4%) employing the Global Health Professions Student Survey (GHPSS) questionnaire; n= 838; [20.89 (SD± 0.94) years] was conducted in Mysore, India. A descriptive, comparative and multivariate analysis was performed. Results: The number of students who received formal training in smoking cessation approaches was only 14.04%. In total, two-thirds of medical students, compared to 38.9% of dental, 29.7% of pharmacy, and 11.40 % of nursing students, learned “the reasons why people smoke” as a part of their formal training. However, only less than a quarter of the study population were aware of the role of antidepressants in nicotine cessation medications. The total prevalence of tobacco use was 28.9%. A total of 37.72% wanted to quit smoking, while a mere 1.2% had sought any professional help to do so. Conclusions: Tobacco use in HCS, apart from personal health risks to themselves, may potentially affect their future commitment to support patients in tobacco cessation. There is a need for further research into tobacco prevention and cessation programs tailored to the needs of student groups. There is a need for an updated curriculum for tobacco cessation strategies and more research into better cessation strategies.