Levels Of Clinical Experience Research Articles

Clinical Capabilities and Limitations in the Use of Modern Technologies in Echocardiography

Transthoracic echocardiography is the most frequently used method for detection of impaired contractility of the left ventricle. In most cases, assessment of contractility is carried out visually "by eye", what increases its subjectivity, is operator-dependent in nature and requires a high level of clinical training and experience of the researcher. Currently in the arsenal of a specialist in echocardiography for quantification of left ventricular contractility sometimes is used tissue Doppler echocardiography, however, this method requires special settings of the image (high frame rate, the allocation of zones of interest), depends on the scanning angle and on operator qualification, has high intra - and inter-operator variability, and significantly increases the duration of the study. Therefore, this method has not received wide clinical application. In the 2000s years an innovative technique of speckle tracking emerged, which, unlike tissue Doppler echocardiography is efficient, does not burden a researcher with time costs, has a low intra - and inter- operator variability, does not depend on scan angle. In recent years, this technology is actively implemented in clinical practice for detection of subclinical impairment of the functional state of the myocardium in different diseases and syndromes: arterial hypertension, ischemic heart disease, valvular defects, and congenital heart disease, heart failure, cardiomyopathy of different etiology.

Differences in near miss incident reports across clinical experience levels in nurses: using national wide data base from the Japan council for quality healthcare

Introduction: Medical incidents occur frequently, necessitating a more effective prevention policy. Nurses have the highest employment rates in the healthcare occupations; therefore, they are a key to improving patient safety. Most reports of errors have focused on medicine errors by nurses or patient falls; however, the effects of different types of error and nurses’ experience have not been examined. The present study aimed to elucidate the factors that influence differences in reported near-miss incidents across clinical experience levels and department assignments. Material and Methods: A quantitative study was conducted using published data from the Japan Council for Quality Health Care. We analysed clinical experience level by near miss types. Results: A total of 17,105 cases were analysed (14,896 drug near misses, 1,857 medical device near misses, and 162 nursing near misses). Participants had a mean of 7.4 years of experience and a mean of 2.3 years within the department. Statistically significant differences between clinical experience level, events, drug administration, and medical devices used were observed. However, no differences were found in terms of nursing care near misses. Length of department assignment was related to the “human factors” in participants at Novice/Advanced beginner levels, as well as “environment/facilities and devices” in those at Competent and Proficient/Expert levels. The percentage of “environment/facilities and devices” that caused near misses with drugs and medical devices increased as clinical experience increased. Conclusion: The present study described the characteristics of clinical experience levels, providing meaningful information useful for developing new educational paradigms for effective training.

Early Mobilization of Patients With External Ventricular Drains: Does Therapist Experience Matter?

Objective: Growing evidence supports the benefits and safety of early mobilization of patients in intensive care units. Frequently cited barriers to early mobilization are insufficient staffing and training. This study examines the number of professionals and years of physical therapy or occupational therapy experience needed to mobilize patients in neuro-intensive care units with external ventricular drains (EVDs). Design: The study was a retrospective review of a prospective quality improvement database, which includes 185 encounters with 90 patients with EVDs from June 2014 through July 2015. Results: Ninety-five percent of encounters required at most 2 professionals for mobilization. No evidence of association between number of people required to mobilize and highest activity achieved was found. Neither the number of people to mobilize patients nor the primary therapist's years of experience were associated with the type of activity achieved or the occurrence of an adverse event. Conclusion: This analysis suggests that patients with EVDs in the neuro-intensive care unit can be safely and efficiently mobilized by physical therapists and occupational therapists of varying levels of clinical experience. Early mobilization of patients with EVDs may demand fewer staff resources than perceived by clinicians.

Influence of clinical experience on accuracy of virtual orthodontic attachment bonding in comparison with the direct procedure.

To compare the accuracy of bonding orthodontic attachments in a digital environment with the direct bonding procedure depending on the level of the orthodontist's clinical experience. A total of 1120 artificial teeth of 40 identical models (20 solid sets + 20 digital sets) were divided into four groups: (1) direct bonding (experienced clinicians). (2) direct bonding (postgraduate students), (3) virtual bonding (experienced clinicians), and (4) virtual bonding (postgraduate students). The differences in individual position of the placed attachments were measured after three-dimensional superimposition of the models using customized software. In the interoperator comparison, experienced clinicians were more exact than postgraduate students in virtual bonding in the angular dimension. Between the bonding techniques, virtual bonding was more accurate than the direct technique. The prevalence of errors was higher in the direct procedure than virtual bonding, and the errors were more significant in the premolar and molar teeth. Clinical experience had a positive influence in achieving a higher rate of correctness/accuracy in the angular dimension only during virtual bonding. Virtual bonding was more accurate than direct bonding in the vertical and horizontal dimensions. Early diagnosis of errors in the bonding positions of attachments could be of benefit to both clinicians and patients by predicting discrepancies that may lead to undesirable orthodontic movements.

Nurses' Experience of Body Nursing Care: A Qualitative Study.

As a practice, nursing centers on patients' bodies and how they live the experience of illness and disability through their bodies (embodiment). International nursing studies conducted on the topic of body care primarily include theoretical studies, whereas empirical studies remain sparse. The aim of this study was to describe nurses' perceptions of the role of their bodies and the bodies of patients during body care. This study used a descriptive phenomenological study based on Husserl's philosophical perspective. A purposive sample of 11 Italian registered nurses representing the highest level of nursing education, different clinical experience levels, and different clinical specialties were interviewed. Data were collected between July 2015 and September 2015. Open-ended interviews were analyzed using Giorgi's descriptive phenomenological method. Lincoln and Guba's strategies were used to ensure the trustworthiness of the data. In addition to the overarching theme, "Body care is the heart of nursing," 4 major themes with 13 subthemes emerged from the data. The 4 major themes were as follows: (1) "Body care encompasses the essence of person"; (2) "Body care touches the heart of person"; (3) "The body generates opposite strategies of care"; and (4) "In time, the body 'nourishes' the helping relationship." Nurses considered body and embodiment concepts central to nursing. Body care is treated as an experience with extraordinary emotional contents, allowing nurses to discover the essentials of human nature.

The Value of Shadowing and the Twinkling Artifact in the Diagnosis of Ureteral Stones: A Single-center Study

ObjectiveTo determine and evaluate the value of shadowing and the twinkling artifact (TA) for the diagnosis of ureteral stones. Materials and MethodsRelated ultrasound images from 117 patients with suspected ureteral stones were consecutively collected with optimized machine settings, confirmed by computed tomography and then retrospectively reviewed by 12 physicians who were classified into 3 groups according to their experience levels: elementary, intermediate, and advanced. The shadowing/TA grades were separately evaluated by all the participating physicians in a blinded manner, and the consistency was verified using Kendall's coefficient of concordance (Kendall's W). Furthermore, the diagnostic performance was compared among the groups stratified by physicians’ clinical experience levels and ureteral stone sizes. ResultsUsing shadowing/TA as indicators for ureteral stones, Kendall's W for the TA evaluation was higher than that for shadowing among all the participating physicians and subgroups (P <.05). Furthermore, with no difference in specificity at 100%, the sensitivity of the isolated TA was superior to that of shadowing in groups stratified by the physicians’ clinical experience levels and stone sizes, respectively (P <.05). However, for the respective comparisons of shadowing and the TA among groups stratified by stone sizes, as ureteral stones became larger, the detection sensitivities all significantly increased (P ≤.001). ConclusionAmong physicians, subjective evaluation of the TA is more consistent and has better diagnostic sensitivity than that of shadowing for the diagnosis of ureteral stones, and the stone size may play an important role in the detection sensitivity of these 2 indicators.

Abstract TP457: Implementation of Stroke Champions as an Educational Tool for Improving Nursing Performance During In-hospital Stroke Codes at an Academic Institution: A Pilot Project

Background and Purpose: Identifying in-hospital strokes poses a challenge during stroke codes (SC) because stroke symptoms among hospitalized patients are often confounded with other symptoms and the medical history or symptomatology onset may be unknown by the covering provider. Nursing staff (NS) are frequently the first responders and must be adept at recognizing neurologic changes, as the SC requires accurate identification of stroke symptoms, prompt and reliable collection of sensitive information and compliance to an effective sequence of steps during the SC. Methodology: A retrospective analysis of in-hospital SC activations from January 1 st to December 31 st , 2017 was performed. Two intensive care units (ICU) and six general floors (GF) were included in this project. We surveyed NS to identify the level of training, clinical experience, and stroke knowledge. Stroke champions (SCH) were recognized in each unit as the most knowledgeable nurses regarding stroke. The SCH initiated the educational process with a lecture series then distributed handouts and a printed algorithm to aid NS during SC in the intervened units. Results: A total of 416 in-hospital SC were activated in 2017. The NS were the first responders in 360 cases (87%). We found that of the in-hospital SC, 29% were activated in the ICU and 71% in the GF. A significant high rate of non-stroke diagnosis was identified in Medical ICU (n=27, 93%), Cardiothoracic ICU (n=48, 67%), Medicine GF (n= 50, 80%) and Oncology GF (n= 54, 80%). A total of 139 nurses were surveyed. In this sample, 89 (64%) nurses have more than five years of clinical experience, 78 (56%) have RN or RN, BSN credentials, and 116 (83%) received some type of stroke training prior to this project. Only 75 (54%) responded correctly to questions about stroke symptoms and mimics. However, 135 (97%) nurses accurately recognized the acronym FAST in acute stroke. Conclusions: Prompt diagnosis is essential in patients experiencing acute stroke as treatment efficacy is highly time-dependent. The educational intervention by our SCH and implementation of a SC algorithm is beneficial to improve recognition of stroke symptoms and the performance during SC activations, increase the accuracy of diagnosis, and ultimately improve patient care and outcomes.

Reproductibilité de la classification de Dorr et de ses index quantitatifs sur des radiographies standard

BackgroundThe Dorr classification is widely used to evaluate femoral bone quality, but it has no clear quantitative criteria. This study aimed to evaluate the reproducibility of the Dorr classification and examine its quantitative indices on plain radiographs, which are suitable for objective classification. HypothesisReproducibility of the Dorr classification is influenced by the clinical experience of the examiners, and radiographic indices are required for this classification. Materials and MethodsOne hundred and one patients were examined using their preoperative plain anteroposterior and lateral radiographs. To evaluate the reproducibility of the Dorr classification, the Dorr type of each patient was judged twice each by three expert hip surgeons and three junior hip surgeons. Indices measured using the plain radiographs were canal-to-calcar ratio, cortical index (CI), and canal flare index. A receiver operating characteristic curve was used to evaluate which measured parameters were suitable as indices for the Dorr classification, which was determined by the consultation among three expert hip surgeons. ResultsRegarding intra-examiner reproducibility, kappa coefficients for the three junior hip surgeons were 0.36, 0.62, and 0.65, whereas those for the three expert hip surgeons were 0.70, 0.86, and 0.87. Regarding inter-examiner reproducibility, the kappa coefficient for the junior hip surgeons was 0.32, whereas that for the expert hip surgeons was 0.52. The CI on the lateral radiograph had the largest area under the curve (AUC) between types A and B, whereas the CI on the anteroposterior radiograph had the largest AUC between types B and C. The respective cutoff points of the CI on the anteroposterior radiograph were 0.58 between types A and B and 0.49 between types B and C. The respective cutoff points of CI on the lateral radiograph were 0.45 between types A and B and 0.28 between types B and C. ConclusionThe intra-examiner reproducibility of the Dorr classification ranged from “fair” to “almost perfect”, whereas the inter-examiner reproducibility ranged from “fair” to “moderate”. Both were influenced by the level of clinical experience of the examiners. The most suitable index for classification using plain radiographs of the hip is the CI on anteroposterior and lateral radiographs. Level of evidenceIV, retrospective study.

Simulators in the training of surgeons: is it worth the investment in money and time? 2018 Jules Gonin lecture of the Retina Research Foundation.

This paper describes transfer of skills obtained from training with the EyeSI virtual reality simulator of ophthalmic surgery to real-life surgical performance. Skills in real-life phacoemulsification surgery were assessed by systematic blinded evaluation of surgical videos based on the OSACCS system. Nineteen Danish cataract surgeons with varying clinical experience levels had their cataract surgery skills evaluated before and after completing a standardized mastery learning program on the EyeSI. It was found that transfer of skills could be demonstrated only for surgeons with a real-life experience of less than 75 completed, independent cases. We could not demonstrate transfer of skills from the EyeSI cataract module to the EyeSI vitreoretinal module, so each subspecialty seems to require specific training. Finally, the discriminative power of EyeSI simulation between emerging surgeons and experts was found to reside only in the first training sessions. The EyeSI simulator in its current state of development, and our implementation of it, seems to require further development before it can be used as a tool to select residents for surgical training and to re-certify more senior surgeons.

Managing sickness absence of patients with musculoskeletal pain \u2013 a cross-sectional survey of Scandinavian chiropractors

BackgroundMusculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners’ practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.MethodsAs part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.ResultsOut of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.ConclusionsWhilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a ‘return-to-work’ rather than a ‘stay-at-home’ approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.

Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures.

Background:Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity.Objectives:The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks.Methods:This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants’ experience level, opinions, and procedural confidence regarding the 4 stations.Results:A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures.Conclusions:This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.

Perception of Facial Esthetics by Laypersons, Dental Assistants, General Dental Practitioners and Dental Specialists

This study sought to assess perception of facial esthetics by laypersons and dental professionals. Three standard photographs were digitally manipulated involving three facial characteristics; facial symmetry, facial profile and facial vertical proportions. A sample of 465 [142 laypersons (LP), 97 dental assistants (DA), 152 general dental practitioners (GDP) and 74 dental specialists (DS)] evaluated the standard and the manipulated images on a visual analogue scale ranging from 1 (the less pleasant image) to 5 (the standard image). The responses were analyzed using Kruskal-Wallis and Mann-Whitney tests. A p value of <0.05 was considered significant. The overall score was 61.29 ± 16.19% with no statistical difference by gender. GDP showed significantly higher perception score than LP, DA and DS did. Regarding the individual facial esthetic components, females showed significantly better perception for "facial profile", while males showed significantly better perception for "facial symmetry" and "facial vertical proportions". Facial symmetry and facial vertical proportions were perceived differently with the higher perception score for the GDP and the lowest perception scores were for LP. Remarkable variations do exist with regard to facial esthetic perception by LP, DA, GDP and DS, with GDP showed more favorable perception. Perception of facial esthetics by laypersons and dental practitioners with a different level of dental education and clinical experience gives an indication about the difference between the patients' desire and the practitioners' perception of such esthetic demands.

Investigation on the Radiation Safety Management in Computed Tomography Radiological Technologists

Background/Objectives: This study aimed at investigating the attitudes, knowledge and behaviors of radiological technologists on radiation, and how they are preparing plans to reduce unnecessary radiation doses on practitioners, patients and their caretakers. Methods/Statistical analysis: This study was conducted with 231 radiological technologists working in a CT examination room. For this, we contacted radiological technologists working at hospitals for at least 1 month from March to April of 2016. The following findings were obtained. Data collected through the survey was analyzed using SPSS ver. 23.0. Findings: Knowledge level of radiation safety management by general characteristics showed statistically significant differences according to clinical experience (p < 0.05), hospital size (p < 0.05), and educational level (p < 0.05). Attitude level of radiation safety management by general characteristics showed statistically significant differences according to age (p < 0.01), marital status (p < 0.01), and hospital size (p < 0.001). Behavior level of radiation safety management by general characteristics showed statistically significant differences according to clinical experience (p < 0.001) and hospital size (p < 0.05). In the relation between knowledge, attitude, and behavior on radiation safety management, higher level of radiation safety management knowledge correlated to higher levels of attitude and behavior. In addition, higher levels radiation safety management attitudes correlated to higher levels of radiation safety management behavior. Improvements/Applications: The correct radiation safety management through practitioner training was necessary to reduce radiation doses on computed tomography radiological technologists and patients.

Reproducibility of the Dorr classification and its quantitative indices on plain radiographs

BackgroundThe Dorr classification is widely used to evaluate femoral bone quality, but it has no clear quantitative criteria. This study aimed to evaluate the reproducibility of the Dorr classification and examine its quantitative indices on plain radiographs, which are suitable for objective classification. HypothesisReproducibility of the Dorr classification is influenced by the clinical experience of the examiners, and radiographic indices are required for this classification. Materials and methodsOne hundred and one patients were examined using their preoperative plain antero-posterior and lateral radiographs. To evaluate the reproducibility of the Dorr classification, the Dorr type of each patient was judged twice each by three expert hip surgeons and three junior hip surgeons. Indices measured using the plain radiographs were canal-to-calcar ratio, cortical index (CI), and canal flare index. A receiver operating characteristic curve was used to evaluate which measured parameters were suitable as indices for the Dorr classification which was determined by the consultation among three expert hip surgeons. ResultsRegarding intra-examiner reproducibility, kappa coefficients for the three junior hip surgeons were 0.36, 0.62, and 0.65, whereas those for the three expert hip surgeons were 0.70, 0.86, and 0.87. Regarding inter-examiner reproducibility, the kappa coefficient for the junior hip surgeons was 0.32, whereas that for the expert hip surgeons was 0.52. The CI on the lateral radiograph had the largest area under the curve (AUC) between types A and B, whereas the CI on the anteroposterior radiograph had the largest AUC between types B and C. The respective cutoff points of the CI on the anteroposterior radiograph were 0.58 between types A and B and 0.49 between types B and C. The respective cutoff points of CI on the lateral radiograph were 0.45 between types A and B and 0.28 between types B and C. ConclusionThe intra-examiner reproducibility of the Dorr classification ranged from “fair” to “almost perfect”, whereas the inter-examiner reproducibility ranged from “fair” to “moderate”. Both were influenced by the level of clinical experience of the examiners. The most suitable index for classification using plain radiographs of the hip is the CI on anteroposterior and lateral radiographs. Level of evidenceIV, retrospective study.

Current Updates on Bone Grafting Biomaterials and Recombinant Human Growth Factors Implanted Biotherapy for Spinal Fusion: A Review of Human Clinical Studies.

Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion. The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion. Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books. Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion. Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.

Factors influencing health practitioners’ cognitive processing and decision-making style

ABSTRACT Successful interventions, healthcare planning, and patient-centered care require explanation, justification, and collaboration through interprofessional clinical decision-making (CDM). Understanding health practitioners’ decision-making styles and influencing factors can enhance CDM capabilities. Health professionals and students (N = 229) completed an online survey on their decision-making styles, interprofessional education, interprofessional practice, discipline education, clinical experience, processing styles, personality, interpersonal motivational factors, and age. To assess the influence of task structure, participants answered CDM questions on a high- and a low-structured case study. Age demonstrated an effect on the level of clinical experience, while clinical experience also mediated the effect of age on rational processing styles. While personality results were mixed, consistent with previous findings, conscientiousness predicted rational processing style. Effects of interpersonal motivation on personality were also mixed, insofar as results indicated an association between conscientiousness and both experiential and rational processing styles. Interpersonal motivation also predicted rational processing styles. The complexity of CDM and factors influencing healthcare practitioners’ processing and decision-making styles was highlighted. To optimize CDM processes by addressing errors and biases, CDM, and practice complexity, healthcare practitioner education should include theory-driven CDM orientation frameworks.

Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP. A self-administered questionnaire was used to collect the data which included a socio-demographic section, self-reports about the work setting, and a clinical experience section. Participants also completed the 15-item Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) questionnaire. The HC-Pairs is scored on a 7-point Likert scale, a high score indicating a stronger belief that pain limits daily function. A total of 213 physiotherapists completed the questionnaire. The mean HC-Pairs score of community-orthopaedics physiotherapists was significantly lower than that of non community-orthopaedics physiotherapists (mean 44.02-+9.44 vs 48.69-+10.89, t=-3.29, P<0.001) indicating that community-orthopaedics physiotherapists hold a weaker belief that pain limits daily function. Analysis suggests that there is a statistically significant difference in the mean HC-Pairs scores between the high-frequency and the low-frequency group (F=4.688, P<0.05) implicating that as physiotherapists experience more frequent encounters with LBP patients, their belief that pain limits daily function of these patients weakens. Work setting is the only variable that predicts the HC-Pairs scores. There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.

MR Pelvimetry for Breech Presentation at Term- Interobserver Reliability, Incidental Findings and Reference Values.

Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental findings noted by different clinicians and assessed potential reference values. In this monocentric study, the radiologic database was searched for obstetric MR pelvimetries with singleton breech pregnancies between 1999 and 2016. 99 consecutive MR pelvimetries were included. A structured, independent review was performed by six observers with three clinical experience levels (attending, fellow, junior resident from the departments of radiology and obstetrics). Image analysis entailed the quantitative assessment of conjugata vera (CV) and diameter transversalis (DT), image quality and incidental findings. Obstetric data was retrieved from the obstetric database for reference value assessment. Interobserver agreement was strong throughout (mean intraclass correlation coefficient range: 0.889 - 0.968). The individual measuring biases ranged between 0 - 2 mm, and the average limits of agreement were ± 3 mm. Regarding the mode of delivery, the recommended cesarean section (rCS) group showed significantly smaller CV measurements (CV: 11.37 ± 0.73, p-value < 0.0001) than any other delivery group. No statistical difference in CV between the vaginal delivery and unplanned cesarean section groups was found (p-value 0.902). DT measurements only showed a significant difference between rCS and elective cesarean section (p-value 0.039). 134 incidental findings were noted. Strong interobserver agreement irrespective of the reader's experience level supports MR pelvimetry as a reliable method for identifying women with fetopelvic disproportion in breech presentation. For a comprehensive appraisal of incidental findings, radiologic expertise is vital. · MR pelvimetry is a reliable method irrespective of the reader's experience level.. · Conjugata vera measurements aid in the prepartal viability assessment of vaginal breech delivery.. · Incidental findings are relatively common.. · von Bismarck A, Ertl-Wagner B, Stöcklein S et al. MR Pelvimetry for Breech Presentation at Term- Interobserver Reliability, Incidental Findings and Reference Values. Fortschr Röntgenstr 2019; 191: 424 - 432.

TF-5 Off-Service Resident ToolBox: A “Moment of Need” Emergency Medicine Curriculum for the Off-Service Rotator

Bedside and experiential learning are essential parts of emergency medicine education. Off-service residents (hereafter referred to as rotators) pose a particularly challenging group with which to engage in on-shift teaching due to their widely varying levels of prior knowledge and clinical experience. The Five Moments of Need Model described by Mosher and Gottfredson was designed for the corporate sector but offers significant parallels to the on-shift learning environment. E-Learning modalities lend themselves well meeting the resident in many “Moments of Need” and offer the rotator an opportunity to maximize their experiential learning during patient care. Prior efforts to develop a standard rotator curriculum predate the American College of Graduate Medical Education Milestones Project and have not been widely adopted. This curriculum uses an E-Learning repository as the core of a rotator curriculum. It augments a multi-modal approach addressing specialty-specific milestones for rotators. Study Objectives: To develop a rotator curriculum offering learning opportunities appropriate to several “moments of need.” After completion of this curriculum, rotators will: 1) Recognize patients with an unstable medical condition requiring acute stabilization, 2) Perform a focused history and physical exam appropriate to a patient’s chief complaint 3) Develop a differential diagnosis and treatment plan emphasizing acute life-threatening conditions. 4) Safely perform select emergency procedures under supervision. Rotators will be provided access to the Off-Service Resident ToolBox 2 weeks prior to the beginning of their rotation. The ToolBox is an online repository of brief written, video and PowerPoint-based modules. ToolBox content includes a practical introduction to the ED, a series of chief-complaint-focused clinical assessment modules, procedure videos, journal club materials, suggested reading and self-study quizzes. Rotators will be encouraged to review the materials prior to their rotation addressing the “Learning for the first time” and “Learning more” moments of need as well as on shift as preparation for patient evaluation addressing the “Applying what you’ve learned” and “When things change” moments of need. Rotators will apply knowledge gained through ToolBox materials and on-shift experience to their critical analysis of a variety of high-yield journal articles in a rotator-specific journal club led by emergency medicine faculty. Rotators will have 2 primary means of evaluation. Content-specific self-study modules are provided in the ToolBox to provide means of self-assessment. Rotators are evaluated by emergency medicine faculty through means of direct observation. Evaluations are milestone-based and completed via electronic survey response. Curriculum evaluation will be based upon before and after surveys assessing rotator confidence in clinical scenario management, content utilization, and satisfaction. Curricula designed for the rotating resident in the Milestones era are not widely available. The ToolBox offers an e-learning based rotator curriculum emphasizing provision of user-friendly modules at high-yield “moments of need” to maximize both clinical performance and experiential learning through direct patient care.

Physiotherapy clinical education in Australia: an exploration of clinical educator characteristics, confidence and training requirements.

Objectives The aim of this study was to describe physiotherapists' involvement, confidence and training needs in the provision of student clinical education (CE) in Australia. Methods A valid and reliable cross-sectional online survey instrument was used to collect data from physiotherapists employed in public and private healthcare facilities in Australia. Survey questions included participant personal and professional characteristics, participation in CE-related continuing professional development (CPD) and confidence in components of CE. Results In all, 170 (34%) physiotherapists (mean age 37 years; mean years clinical experience 13 years) completed the survey. Most participants (68%) were currently involved in CE, over half (56%) had completed CE-related CPD and many (56%) reported a need for more CPD. Participants with no previous CE experience were less confident (P≤0.05) in all components of CE. Participants with less clinical experience were less confident in managing challenging students (P=0.003), multiple students (P=<0.001) and competing workplace and education duties (P=<0.001). Conclusions Physiotherapists with varying professional characteristics were involved in CE. Although many participants had attended CE-related CPD, many reported that more training was required. Future training for clinical educators should be tailored to participants' level of experience and focus on the components of CE in which they feel least confident. What is known about the topic? The ability of physiotherapists to confidently assume a clinical educator role may affect their willingness to be clinical educators in the future and the students' perceptions of clinical placement quality. CPD relating to CE may help prepare physiotherapists for the clinical educator role. What does this paper add? There is a lack of information regarding physiotherapists' involvement in CE, completion of CE-related CPD or perceived levels of confidence in various aspects of the clinical educator role, such as placement organisation, teaching, assessment and the provision of feedback. This study describes the involvement of physiotherapists in CE in Australia, including their demographic and professional characteristics, participation in CE-related CPD and confidence in various components of CE. What are the implications for practitioners? Several recommendations regarding future CE-related CPD have resulted from this study, including tailoring CPD to the needs of physiotherapists based on their level of clinical or CE experience, focusing CPD on the aspects of CE in which physiotherapists feel least confident and raising the awareness of and improving accessibility to CPD opportunities in this area.