Mean Confidence Score Research Articles

Evaluating a training programme at Viet Duc University Hospital in Vietnam.

Vietnam's nursing competency standards (VNCS) were issued in 2012 as the legal framework on which the continuous nursing training programme are designed and developed. The study aimed to assess the knowledge, skills, and attitudes as well as the confidence of nurses regarding wound care at Viet Duc University Hospital before and after a new educational intervention. A comparative descriptive study was carried out in 2014 at Viet Duc University Hospital. The study reviewed knowledge, skills, attitude and confidence among nurses working in seven clinical departments. The data collection tools included a 48-knowledge-item self-administered questionnaire, a sixteen-item skills set, and attitude-item observation sheet and a thirteen confidence level-item observation sheet, adapted for the field of wound care. Data were loaded into Epidata version 3.1 and analysed with SPSS version 16.0. The mean pre-training knowledge, skill, attitude and confidence scores were (117.78±24.94), (53.61±10.26), (54.39±8.02) and (1.18-3.59), respectively, while the corresponding post-training scores were (148.68±16.54), (62.33±8.40), (60.80±8.75) and (1.50-4.15) p<0.0001. This was the first cohort to undergo the new training programme and has shown promising initial results; however, it also demonstrates that the training content, while leading to positive changes, does in some areas need to be further developed and then disseminated across the hospital to all nurses who provide direct wound care for patients.

PTH-122 Assessing The Impact of A Nutritional Course to A Third World Country - Lessons from A BSG-Funded Delegation to Iraq

Introduction Good nutrition is pivotal for ensuring an individuals health and wellbeing. The Iraqi Healthcare system has suffered years of underinvestment, war and turmoil. In particular, services dealing with nutrition and dietetics are often overlooked or entirely non-existent in Iraqi hospitals leading to a significant adverse effect on overall health outcomes. We investigate the usefulness of an intensive nutritional course in improving knowledge and confidence amongst healthcare professionals in Iraq. Methods A BSG-funded delegation visited the University of Kufa, Iraq in January 2016 to deliver an intensive four-day course on clinical nutrition based on the BSG, BDS, and BAPEN guidelines. Each day was dedicated to specific learning outcomes in general dietetic assessment, special situations (including GI nutrition & trauma), paediatric nutrition and obesity nutrition. This free for all course received 20 external CPD credits from the Royal College of Physicians. A detailed pre-course questionnaire was distributed to evaluate understanding of common nutritional problems and confidence in managing these. A subsequent questionnaire one-month following the course evaluated changes to confidence (using a standardised 5 point confidence Likert scale). Results 147 delegates attended the course from 8 of the 19 Iraqi governates. Completed post-course questionnaires were available for 69 individuals (47% response rate). Whilst 88% of attendees did not feel confident diagnosing malnutrition before the course, this improved to 97% of respondents with >3/5 confidence in the post-course questionnaire (67% scoring >4/5). Other observed improvements included mean confidence scores for biochemical workup of patients with suspected malnutrition (2.9 pre-course compared to 4.3 post-course, p Conclusion Clinical nutrition is an often under taught component of medical education. It’s importance; particularly to war-torn developing countries that have no dietetic infrastructure should not be understated. A BSG-funded delegation was able to deliver an intensive 4 day conference to health leaders in Iraq and demonstrated improved knowledge and confidence at dealing with nutritional dilemmas. We welcome BSG-funding for such endeavours and thank them for their support. Disclosure of Interest None Declared

Evaluation of an Electronic Module for Reconciling Medications in Home Health Plans of Care.

Transitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients referred for home healthcare. Nineteen physicians with experience in managing home health referrals were recruited to participate in this within-subjects experiment. Participants completed medication reconciliation for three clinical cases in each of two conditions. The first condition (paper-based) simulated current practice - reconciling medication discrepancies between a paper plan of care (CMS 485) and a simulated Electronic Health Record (EHR). For the second condition (electronic) participants used our medication reconciliation module, which we integrated into the simulated EHR. To evaluate the effectiveness of our medication reconciliation module, we employed repeated measures ANOVA to test the hypotheses that the module will: 1) Improve accuracy by reducing the number of unaddressed medication discrepancies, 2) Improve efficiency by reducing the reconciliation time, 3) have good perceived usability. The improved accuracy hypothesis is supported. Participants left more discrepancies unaddressed in the paper-based condition than the electronic condition, F (1,1) = 22.3, p < 0.0001 (Paper Mean = 1.55, SD = 1.20; Electronic Mean = 0.45, SD = 0.65). However, contrary to our efficiency hypothesis, participants took the same amount of time to complete cases in the two conditions, F (1, 1) =0.007, p = 0.93 (Paper Mean = 258.7 seconds, SD = 124.4; Electronic Mean = 260.4 seconds, SD = 158.9). The usability hypothesis is supported by a composite mean ability and confidence score of 6.41 on a 7-point scale, 17 of 19 participants preferring the electronic system and an SUS rating of 86.5. We present the evaluation of an electronic medication reconciliation module that increases detection and resolution of medication discrepancies compared to a paper-based process. Further work to integrate medication reconciliation within an electronic medical record is warranted.

Abstract 40: Neighborhood Grocery Store Density is Associated with Daily Self-efficacy Among Individuals Enrolled in a Behavioral Weight Loss Intervention Study

Introduction: Neighborhood factors may play an important role in the treatment of obesity. However, it is unclear if exposures to certain neighborhood factors influence self-efficacy among individuals attempting to lose weight. Hypothesis: We hypothesized that individuals living in obesogenic neighborhood environments at baseline would have low self-efficacy for resisting urges to eat beyond their recommended eating plan in a 12-mo weight loss study. Methods: We used ecological momentary assessment (EMA) to collect daily data on self-efficacy with an EMA question: How CONFIDENT are you that, if you have an urge to go off your healthy lifestyle plan, you can resist the urge? (value 1 to 10) This EMA question was delivered randomly an average of 5 times/day on a smartphone. Residential address at baseline was geocoded using ArcGIS software and key neighborhood measures (e.g., grocery store and restaurant density, proportion of Black and low income residents, index of neighborhood socioeconomic disadvantage (NSED)) were linked at the census tract level. Data were analyzed using descriptive statistics and linear mixed modeling. Results: The sample (N=136) was predominately female (90%), White (80%), mean (SD) age 51.3 (10.3) years, and mean BMI 34.1 (4.6) kg/m 2 . The residential neighborhoods of participants were predominantly White, middle to high education level, and low poverty. The mean confidence score decreased from 7.3 at month 1 to 6.8 at month 12 (p &lt;.001). A higher level of baseline neighborhood grocery store density was associated with a higher confidence score ( p = .037) (see table). No other neighborhood factor was associated with confidence score. Conclusion: Neighborhood factors, specifically access to grocery stores, may affect an individuals’ ability to lose or maintain weight loss by supporting one’s confidence to maintain a healthy lifestyle. This study needs to be replicated in a larger cohort with a more diverse neighborhood representation.

Patients' attitudes towards the participation of medical students in clinical examination and care in Western Saudi Arabia.

Background and Objectives:Patients are essential for the acquisition and development of medical students clinical skills for their tasks. The study aimed to identify factors that influence patients’ attitudes towards the involvement of medical students in clinical examination and care in Western Saudi Arabia.Methods:A cross-sectional study using self-administered questionnaire was conducted among Saudi and non-Saudi patients at two university hospitals in Jeddah, Western Saudi Arabia. Information sought included demographic characteristics (age, gender, educational level, job, income, and marital status); patients’ attitude and comfort level towards different types of students’ involvement; factors influencing patients’ cooperation with medical students (students’ level of training, manner, skills, and attire. All these were assessed on a five-point Likert scale. Data was entered and analyzed using SPSS v 19.Results:Four hundred and seventeen adult patients participated. Fifty-one percent indicated a positive attitude towards involving medical students in clinical examination and care. Female and young patients (<45 years old) were more likely to be negative in their attitude and be less comfortable towards involving medical students in their care. The highest overall mean comfort score was with medical students taking history followed by observations and less invasive examination. Patients’ mean confidence scores regarding students’ attire were the highest for female traditional attire and for scrub suit for males.Conclusion:Of the influential factors that could affect patients’ willingness to cooperate with medical students, clinical skills followed by manner and level of training ranked first. Ensuring that students mastered specific procedures before coming into direct contact with patients using patient simulators, for example, would improve patients’ acceptance of student participation.

Dual-source CT in blunt trauma patients: elimination of diaphragmatic motion using high-pitch spiral technique.

The purpose of this study was to compare diaphragmatic motion on dual-source high-pitch (DS-HP) and conventional single-source (SS) CT scans in trauma patients. Seventy-five consecutive trauma patients who presented to a level one trauma center over a 6-month period were scanned with a standardized whole body trauma CT protocol including both DS-HP chest (pitch = 2.1-2.5) and SS abdominal CT scans. Subjective analysis of diaphragmatic motion was performed by two readers using a four-point motion scale in seven regions of the diaphragm on coronal and axial slices. An overall confidence score to exclude a diaphragmatic tear was determined (1 to 10, 10: completely confident and 1: impossible to exclude). Wilcoxon rank sum tests were used for statistical analysis, and p < 0.05 was considered significant. Mean confidence score of 9.85 for DS-HP was significantly better than the mean score of 7.66 for SS images (p < 0.0001). Diaphragmatic motion scores and subjective diaphragmatic motion artifact on coronal and axial images were significantly better for DS-HP images in all areas when compared individually (p < 0.0001) and overall (p < 0.0001). Regions of DS-HP (99.2 %) were diagnostic, whereas only 87.0 % % regions on SS were. Complete agreement of motion scores was present in 92 % of cases, with moderate overall agreement for confidence to exclude a diaphragmatic tear (κ = 0.45). Dual-source high-pitch CT scanning is advantageous as it allows for significantly better evaluation of diaphragmatic structures by minimizing motion artifacts on images of freely breathing trauma patients.

The Evolution of an Elective in Health Disparities and Advocacy: Description of Instructional Strategies and Program Evaluation.

Health disparities remain pervasive in the United States. Training future physicians to address health disparities requires attention to both systemic and provider causes of disparities, but comprehensive curricula are lacking. Albert Einstein College of Medicine in Bronx, New York, offers a 13-session health disparities elective to first-year medical students. The curriculum covers three main content areas: background, provider contributions to health disparities, and systemic contributions to health disparities (i.e., social determinants of health). Teaching methods included didactic and multimedia presentations, reflective discussions, and skill-building seminars (e.g., addressing subconscious assumptions and advocacy training).The authors evaluated the course in 2010-2013 by comparing students' summary scores for knowledge, attitudes, and self-reported confidence on pre- and postintervention tests. They investigated associations between students' sociodemographic characteristics and changes in summary scores. Scores increased significantly in each domain: Mean knowledge scores increased from 63.6 (± 10.0), out of 100, to 76.4 (± 12.8); mean attitudes scores increased from 16.7 (± 1.9), out of 20, to 18.2 (± 1.1); mean confidence scores increased from 10.7 (± 1.5), out of 16, to 14.4 (± 1.7). Younger students (< 24) had greater changes in confidence than older students. Other sociodemographic characteristics were not associated with changes in any domain. Exposure to health disparities instruction is important for medical students. The authors' experience provides insights for incorporating such material into the compulsory curriculum. Future evaluation of outcomes from similar curricula should include measures of clinical behaviors (e.g., through clinical examinations).

Diagnosis of acute cholecystitis: why do patients get multiple studies?

The aim of this study is to establish factors affecting total number of imaging studies performed for acute cholecystitis (AC) prior to surgery. The study included subjects with cholecystectomy and pathologic diagnosis of AC 1/1/05-1/1/14 and imaging studies (computed tomography (CT), ultrasound (US), and/or cholescintigraphy) within 7 days of surgery. The subjects were separated into groups based on modality of the first study. For each subject, report of the first study was reviewed for report's confidence in diagnosis of AC (scored 1-5 on Likert scale: 5 = definitely AC, 1 = definitely no AC), recommendation of additional study, clinical history concerning for AC (history of right upper quadrant pain, cholelithiasis, and/or "rule out AC"). There were 219, 339, and 38 subjects in CT, US, and cholescintigraphy groups, respectively, with mean confidence scores of 3.7 (± 1.2), 3.7 (± 1.1), and 4.7 (± 0.9), respectively (p < 0.001). Prior to surgery, only one study was performed in 21.9 % (48/219) of CT group, 70.2 % (238/339) of US group, and 71.1 % (27/38) of cholescintigraphy group (p < 0.0001). Compared to the US group, the odds of undergoing additional study were 11.8 times higher (p < 0.001) in CT group and 1.7 times higher (p = 0.229) in cholescintigraphy group, adjusting for age, sex, time interval between first study and the surgery, confidence score, recommendation of follow-up study, and clinical history concerning for AC. Patients with AC and CT as the first study are more likely to undergo additional imaging studies prior to surgery as compared to US or cholescintigraphy.

Subjective criteria associated with return-to-play in sports physical therapy

AbstractIntroduction The Subjective Daily Assessment Scale (ESAD) is based on the visual analog scale (VAS) and assesses six parameters (pain, edema, heat, mobility, sensitivity, and confidence).Objective This study aimed to examine the association between the analyzed variables as assessed by the ESAD and physical therapy clinical discharge and return-to-play of injured athletes.Method Eighty-one patient records of athletes were analyzed; mean sample age was 23.9 ± 6.3 years. The athletes received treatment through the Sports Physical Therapy program of Santa Catarina State University, Brazil, between 2008 and 2011. Six parameters were ranked on a scale from 0 to 10, with 0 being the best possible condition and 10 the worst. Data analysis was conducted using stepwise Cox regression.Results At the time of the injury, the mean score for confidence was 5.82 ± 0.48, and at the time of return-to-play, it was 0.48 ± 1.1; the mean score for pain decreased from 3.7 ± 2.64 to 0.34 ± 0.83. However, due to the strong association between pain and confidence, only confidence remained in the final model. For each reduction in the value reported for confidence, the probability of return-to-play was 0.62 times greater.Conclusion The results showed that confidence was the best variable for predicting athlete return-to-play.

E-learning and near-peer teaching in electrocardiogram education: a randomised trial.

Near-peer teaching and electronic learning (e-learning) are two effective modern teaching styles. Near-peer sessions provide a supportive learning environment that benefits both the students and the tutor. E-learning resources are flexible and easily distributed. Careful construction and regular editing can ensure that students receive all of the essential material. Theaim of this study is to compare the efficacy of e-learning and near-peer teaching during the pre-clinical medical curriculum. Thirty-nine second-year medical students were consented and randomised into two groups. Each group received teaching on electrocardiogram (ECG) interpretation from a predefined syllabus. Eighteen students completed an e-learning module and 21 students attended a near-peer tutorial. Students were asked to complete a multiple-choice exam, scored out of 50. Each student rated their confidence in ECG interpretation before and after their allocated teaching session. The near-peer group (84%) demonstrated a significantly higher performance than the e-learning group (74.5%) on the final assessment (p=0.002). Prior to the teaching, the students' mean confidence scores were 3/10 in both the near-peer and e-learning groups (0, poor; 10, excellent). These increased to 6/10 in both cases following the teaching session. Both teaching styles were well received by students and improved their confidence in ECG interpretation. Near-peer teaching led to superior scores in our final assessment. Given the congested nature of the modern medical curriculum, direct comparison of the efficacy of these methods may aid course design. The aim of this study is to compare the efficacy of e-learning and near-peer teaching.

Development and evaluation of a 3D printed endoscopic ampullectomy training model (with video)

Endoscopic ampullectomy is a technically challenging, high-risk procedure with limited training opportunities. Although simulation models can assist with endoscopic skill acquisition, an ampullectomy model does not currently exist. To develop a training model that can be used to improve technical skills, knowledge, and confidence in performing endoscopic ampullectomy. Experimental study. Tertiary hospital innovation laboratory. Twenty-one endoscopists attending an endoscopic resection workshop. A prototype for endoscopic ampullectomy was created by computer-aided design and 3-dimensional printing of an ampullary mount and base to which a chicken heart was attached and inserted into a silicone stomach-duodenum model. Study participants performed an ampullectomy and evaluated the prototype with a pre- and postampullectomy questionnaire by using a scale of 1 to 5 (very low to very high). Evaluation of core procedural steps, technical and visual realism, and proceduralist technical knowledge and confidence. Sixteen endoscopists participated in the study. All core procedural steps were completed by 14 participants. The mean overall technical and visual realism scores were 3.1 (standard deviation [SD], 0.9) and 3.2 (SD, 0.9), respectively. Ten participants (10/15, 66.7%) thought that their technical knowledge had improved, and 11 thought that it would increase further with additional sessions (11/15, 73.3%). Mean confidence score before and after using the model was 2.2 (SD, 1.2) and 2.9 (SD, 1.1), respectively (P=.132). Pilot study, lack of follow-up of participants' endoscopic practice after model experience. Although further studies are necessary for validation, this novel prototype appears useful for endoscopic ampullectomy training.

Impact of the Diabetes Inpatient Care and Education (DICE) project and the DICE Care Pathway on patient outcomes and trainee doctor's knowledge and confidence.

To evaluate the impact of the Diabetes Inpatient Care and Education project and a comprehensive diabetes care pathway, the Diabetes Inpatient Care and Education Care Pathway, on patient outcomes and on the knowledge and confidence of trainee doctors. The effect on patient outcomes was evaluated by comparing the National Diabetes Inpatient Audit data before (2012) and after (2013) implementing the Diabetes Inpatient Care and Education project. The impact on trainee doctors was evaluated using the Modified Kirkpatrick model. Just before the project began and again 3months later, trainee doctors were surveyed to assess their knowledge and confidence in inpatient diabetes care. Patient harm was found to have been reduced significantly when National Diabetes Inpatient Audit data for 2012 and 2013 were compared. Severe hypoglycaemia decreased from 15.4 to 9.7%, medication errors from 56.9 to 21.1% and insulin errors from 31 to 7%. Across the 96 trainee doctors surveyed, the mean (sd) knowledge and confidence scores increased significantly (P<0.001 for both) from 57.1 (16.8) and 61.8 (14.9) to 68.4 (13.3) and 74.3 (11.7), respectively. The Diabetes Inpatient Care and Education project and the Diabetes Inpatient Care and Education Care Pathway improved patient outcomes and the knowledge and confidence of trainee doctors in this hospital. The impact of a similar project in other hospitals needs to be evaluated.

G181(P) Reflections on safeguarding training: what new skills do paediatric trainees value?

Aims Providing effective safeguarding training to paediatric trainees is vital. The RCPCH approved ‘Child Protection Recognition and Response Course’ utilises pre-course and face-to-face components with role play communication scenarios, and assessment by senior paediatricians. We aimed to investigate common themes in learning which were beneficial in skill acquisition. Methods 82 paediatric trainees participating in the ‘Child Protection Recognition and Response Course’ were given anonymous pre-course questionnaires and an on-line questionnaire six weeks afterwards. Four questions were posed utilising Likert scales, with an additional post-course free text question (Table 1, responses, Table 2, confidence scores and Table 3, most common themes). Conclusions Trainees had lowest perceived confidence scores in communicating safeguarding concerns with caregivers, and in relevant referral and legal processes. These were the two areas with the greatest improvement in mean confidence score after the course, although there was clear improvement in all domains. Additionally this was mirrored in the most frequent themes of valued learning: useful approaches when speaking to parents about safeguarding concerns and understanding referral and legal processes.

Nutrition in the University of Cambridge Medical Curriculum – Student Perspectives

The Cambridge Nutrition Education Review Group (NERG), is comprised of doctors, dietitians and nutritionists particularly within the University of Cambridge, where we evaluated nutrition education awareness in 120 undergraduate medical students (year 4 of 6). Participants were asked to complete a carefully structured questionnaire assessing experience and self-awareness of nutrition related content in the medical curriculum. A total of 39 questions were asked, and each question carried equal weighting. Of these, 11 questions were opinion based, 24 consisted of self-perceived competency questions and there were 2 questions with reference to the quality and quantity of nutrition education in their learning experience to date. When asked about opinions on nutrition education, 90% students agreed that a multidisciplinary patient-centred approach would be beneficial. 89% of students also reported patients requiring specific nutritional advice should be referred to a nutritionist/dietitian. Out of a maximum confidence score of 130 the mean confidence score was calculated as 77 (59.2%; SD± 17) and the lowest recorded score was 35 (27%). Figure 1. denotes perceived quality and quality of current nutrition teaching. These findings are consistent with the literature from other medical schools worldwide and highlight the ongoing need to work globally to strengthen medical nutrition education, through a multi-disciplinary approach. Figure 1.The quality and quantity of nutrition teaching within the Cambridge University medical degree Figure 1a. Quantity Figure 1b. Quality

Pre-interns: ready to perform?

There is an expectation that interns can perform the core procedural skill of male catheterisation; however, it is unclear if our medical graduates are competent to do so, because there is no formal practical skills exit assessment in our current programme. We sought to investigate the level of experience, the self-reported confidence, and measured competency of our pre-intern (PRINT) students to perform the procedural skill of male catheterisation. We asked 100/147 (68%) PRINT students to complete a questionnaire to elucidate their experience and confidence prior to being practically assessed on a plastic manikin, using a faculty member validated 26-item checklist. Students were also invited to attend focus groups to help identify factors that had contributed to their practical performance. Between 2010 and 2012, 100/147 (68%) PRINT students completed a questionnaire prior to being formatively assessed. The mean score for self-reported confidence was 78.3/100 (95% CI 74.8-81.8), and the mean performance score was 85.6/100 (95% CI 83.2-87.9); however, the correlation coefficient between the confidence score and performance score was weak (r = 0.18). Three focus groups were conducted, with a total of 12/100 (12%) students attending. Although students reported that they had sound knowledge of the skill, the lack of opportunity to perform the skill in the clinical setting had led to mediocre performance outcomes. We found no significant correlation among the level of experience, the self-reported ability and actual performance when students were assessed under direct observation.

Board #134 - Research AbstractThe Effect of Hybrid Learning with Nuring Students’ Clinical Competency

Hypothesis In most nursing curricula, simulation and PBL (problem-based learning) are used solely and separately as teaching and learning tools. Nurse educators should facilitate complex clinical experiences and utilize more complex and mixed education strategies to enhance nursing students’ clinical reasoning in order to improve the comprehensiveness and accuracy of nursing students’ clinical judgment. In the present study, simulation is combined with PBL as a hybrid framework or a learning strategy including lectures, discussion using problem-based learning modules, self-directed learning, and real situation practice with human patient simulators [HPS] (Lee et al., 2009). Moreover, there is no research in pediatric nursing literature that examines the effect of hybrid learning with combined simulation and problem-based learning. Hence, the purpose of this study is to test students’ clinical competency to assess the effectiveness of the combined teaching method. Methods The bronchiolitis module in the present study was designed based on the PBL and Simulation Model Framework (Barrows and Tamblyn, 1980; Jeffries, 2005). The Hybrid learning combining simulation with PBL was used to assess clinical competency including knowledge, confidence, and students’ satisfaction. This is a comparison study with three education modalities: PBL group (experimental group 1, E1), simulation with PBL group (experimental group 2, E2), and control group (C). We used descriptive, paired t-test statistics, one-way ANOVA, and post-hoc test (Duncan test) for data analysis using SPSS version 18.0 program. A convenient sample of 195 senior nursing students from three nursing schools located in Seoul and Chuncheon, South Korea participated in this study from Sep 1st to Dec 10th, 2013. Results There were no statistically significant differences between the groups in prior simulation experiences (χ2=.396, p=.529), and baseline knowledge (7.80±1.11 versus 7.79±1.99, t=.020, p=.984). There were significant difference in the mean score of knowledge difference (post-pre) among E1 (1.42±2.49), E2 (1.77±2.11), and C (0.44±2.74) (F=14.718, p<.001). There were significant difference in the mean score of confidence among E1 (3.69±0.30), E2 (3.57±0.33), and C (3.38±0.44) (F=12.693, p<.001). There were significant differences in the mean satisfaction total score among E1 (4.67±0.39), E2 (4.17±0.53), and C (3.48±0.62) (F=93.471, p<.001). Conclusion This result could provide a much-need template or starting point for educators who desire to introduce simulation combined with PBL as a teaching-learning strategy in pediatric nursing courses. It is also necessary to monitor the effectiveness of combined simulation with PBL education. New approaches and strategies combined simulation with PBL for teaching critical thinking, clinical assessment, effective communication, and technical skills will be required to meet the demands of the new roles and responsibilities faced by nurse educators and their students.

148: Improving Medical Students' Confidence and Interviewing Skills Regarding Adolescent Interviewing

The adolescent interview is a challenging task that requires strong communication skills developed through practice and training To explore whether receiving structured feedback from an adolescent and mother Standardized Patient (SP) pair improves medical students' confidence regarding interviewing adolescents. Secondly, to identify self-perceived learning needs in the adolescent interview. Participants were medical students undergoing their core Pediatric Clerkship Rotation. Students were randomized into two groups and asked to rate their confidence levels involving basic communication components of adolescent interviewing on a 13-item structured questionnaire. Following an interview with an adolescent SP and mother pair, one group received structured feedback (F1) on their performance and a second group received no structured feedback (F0). After the SP pair encounter, students were asked to rate their confidence levels a second time using the 13-item questionnaire. Students also ranked self-perceived learning needs in six components of adolescent medicine. Students who received structured feedback (n=25) on their adolescent interviewing skills from an SP pair showed an increase in mean confidence scores on all the 13-item structured questions. Mann-Whitney analysis comparing post-intervention confidence scores between the feedback, (F1) and no feedback (F0) groups showed that the F1 group (Mdn=27.58) had a significantly higher mean confidence score on Question 3 ‘Physical Exam’ than did the F0 group (Mdn=17.28), U=135.50, z=−2.97, P=0.001. The F1 group (Mdn=26.14) also had a significantly higher mean confidence score on Question 6 ‘Sexual Issues’ than the F0 group (Mdn=19.08), U=171.50, z=−1.93; P=0.023. The F1 group demonstrated a trend towards increased mean confidence scores post-intervention on questions that were directly referenced by the structured feedback tool used by the SP pair. The six ranked self-perceived learning needs indicated students felt least prepared for ‘Sexuality Questioning’ and most prepared for ‘Physical Examination’. An SP interview followed by structured feedback from the SP pair improved medical students' confidence level in their adolescent interviewing skills. This study also highlighted important areas of the adolescent interview that required further training, which have since been incorporated into the undergraduate medical training at our institute. Lastly, structured feedback was shown to be a useful tool in the adolescent interview and was further incorporated into our curriculum.

Ultrasound-assisted Lumbar Puncture in Pediatric Emergency Medicine

BackgroundUltrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting. ObjectiveTo assess whether ultrasound increases provider confidence in identifying an insertion point for lumbar puncture. MethodsA feasibility study was conducted using a convenience sample of pediatric emergency patients requiring lumbar puncture. Provider confidence in selecting a needle insertion site for lumbar puncture using ultrasound assistance was compared to provider confidence using traditional landmarks alone. A simple technique using a linear probe is described. ResultsNineteen patients were included in the study, with the primary end point the mean confidence score (based on a five-point Likert scale) in identifying a needle insertion site prior to and after using ultrasound. Using the Wilcoxon signed-rank test, the mean confidence score was 2.89 with the landmark procedure alone, and 4.79 with ultrasound assistance, yielding an average score difference of 1.90 (95% confidence interval 1.23–2.56; Wilcoxon p < 0.001, paired t-test p < 0.001). Thus, compared to the landmark procedure, the use of ultrasound was associated with a significantly higher average confidence score. ConclusionThe use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.

Prenatal breastfeeding confidence is not associated with infant feeding method at one month postpartum (LB479)

Background and Objective: Previous studies have observed a positive relationship between breastfeeding confidence and breastfeeding duration. The objective of this study was to describe associations between prenatal confidence and breastfeeding at one month postpartum.Methods: Expectant mothers planning to breastfeed for the first month postpartum were recruited from clinics and physicians’ offices. Maternal breastfeeding confidence was assessed in the third trimester of pregnancy using a 10‐item written survey developed by O’Campo et al. Pattern of infant feeding (fully formula fed or partially/fully breastfed) was determined at one month postpartum by telephone interview.Results: Of the 60 subjects who completed all study requirements, most were White (85%), educated beyond high school (72%) and married (73%). Initially, survey structure and reliability were assessed by exploratory factor analysis and Cronbach’s alpha. Results indicated a unidimensional solution was optimal with a Cronbach’s alpha value of 0.839 indicating good internal consistency. The mean confidence score was 4.6 + 0.82. At one month postpartum, 22 mothers (37%) reported formula‐feeding and 38 (63%) reported breastfeeding their infants. There was no significant difference in confidence score between mothers who formula‐fed and those who breastfed their infants.Conclusion: Findings from the current study are not in agreement with previous research on breastfeeding confidence. Differences may be due to the limited time frame and/or small sample size in the current study.

Training readers to improve their accuracy in grading Crohn’s disease activity on MRI

To prospectively evaluate if training with direct feedback improves grading accuracy of inexperienced readers for Crohn's disease activity on magnetic resonance imaging (MRI). Thirty-one inexperienced readers assessed 25 cases as a baseline set. Subsequently, all readers received training and assessed 100 cases with direct feedback per case, randomly assigned to four sets of 25 cases. The cases in set 4 were identical to the baseline set. Grading accuracy, understaging, overstaging, mean reading times and confidence scores (scale 0-10) were compared between baseline and set 4, and between the four consecutive sets with feedback. Proportions of grading accuracy, understaging and overstaging per set were compared using logistic regression analyses. Mean reading times and confidence scores were compared by t-tests. Grading accuracy increased from 66 % (95 % CI, 56-74 %) at baseline to 75 % (95 % CI, 66-81 %) in set 4 (P = 0.003). Understaging decreased from 15 % (95 % CI, 9-23 %) to 7 % (95 % CI, 3-14 %) (P < 0.001). Overstaging did not change significantly (20 % vs 19 %). Mean reading time decreased from 6 min 37 s to 4 min 35 s (P < 0.001). Mean confidence increased from 6.90 to 7.65 (P < 0.001). During training, overall grading accuracy, understaging, mean reading times and confidence scores improved gradually. Inexperienced readers need training with at least 100 cases to achieve the literature reported grading accuracy of 75 %. • Most radiologists have limited experience of grading Crohn's disease activity on MRI. • Inexperienced readers need training in the MRI assessment of Crohn's disease. • Grading accuracy, understaging, reading time and confidence scores improved during training. • Radiologists and residents show similar accuracy in grading Crohn's disease. • After 100 cases, grading accuracy can be reached as reported in the literature.