Outpatient Education Research Articles

Experiences of Physical Therapists and Professional Leaders With Implementing a Toolkit to Advance Walking Assessment Poststroke: A Realist Evaluation.

ABSTRACTObjectiveThe iWalk study showed significant increase in use of the 10-Meter Walk Test (10MWT) and 6-Minute Walk Test (6MWT) poststroke following provision of a toolkit. This paper examined the influence of contextual circumstances on use of the toolkit and implementation strategy across acute care and inpatient and outpatient rehabilitation settings.MethodsA theory-based toolkit and implementation strategy was designed to support guideline recommendations to use standardized tools for evaluation of walking, education, and goal-setting poststroke. The toolkit comprised a mobile app, video, and educational guide outlining instructions for 3 learning sessions. After completing learning sessions, 33 physical therapists and 7 professional leaders participated in focus groups or interviews. As part of a realist evaluation, the study compared and synthesized site-specific context-mechanism-outcome descriptions across sites to refine an initial theory of how the toolkit would influence practice.ResultsAnalysis revealed 3 context-mechanism-outcomes: (1) No onsite facilitator? No practice change in acute care: Without an onsite facilitator, participants lacked authority to facilitate and coordinate the implementation strategy; (2) Onsite facilitation fostered integration of select practices in acute care: When onsite facilitation occurred in acute care, walk test administration and use of reference values for patient education were adopted variably with high functioning patients; (3) Onsite facilitation fostered integration of most practices in rehabilitation settings: When onsite facilitation occurred, many participants incorporated 1 or both tests to evaluate and monitor walking capacity, and reference values were applied for inpatient and outpatient education and goal setting. Participants preferentially implemented the 10MWT over the 6MWT because set-up and administration were easier and a greater proportion of patients could walk 10 m.ConclusionFindings underscore contextual factors and activities essential to eliciting change in assessment practice in stroke rehabilitation across care settings.ImpactThis study shows that to foster recommended walking assessment practices, an onsite facilitator should be present to enable learning sessions and toolkit use.

Emergency Department Utilization of Adult Cancer Patient in Korea: A Nationwide Population-Based Study, 2017-2019.

PurposeThe current study aimed to identify the overall characteristics of cancer-related emergency department (ED) visits by adult in Korea, including analyses of factors associated with ED stay time and outcomes nationwide.Materials and MethodsWe collected data on cancer-related ED visits from the National Emergency Department Information System (NEDIS) database between 2017 and 2019.ResultsED visits by cancer patients comprised 5.5% (667,935 visits) of total ED visits from 2017 to 2019, which was slightly higher than in other counties. Patients with cancer who visited the ED were over 50 years old, the majority being males, and patients with cancer visited EDs in certified tertiary hospitals more frequently than patients without cancer. In multivariate analyses, the adjusted odds ratio for a length of stay more than 8 hours in the ED of certified tertiary hospitals was 126.34 (95% confidence interval, 1.422 to 1.460) when compared to hospitals. Nevertheless, the longer the patients stayed in the ED, the more likely they were to be admitted.ConclusionThe longer ED stay and higher proportion of cancer patient hospitalizations suggest that cancer patients visit ED to be admitted as well as to receive acute care. The frequency of ED visits and admission may be adjusted to some extent depending on outpatient education, such as self-management of symptoms and situations. Improving cancer care in local communities should be met though provisions such as linking treatment between hospitals or supplying appropriate medical personnel, even for the efficient use of ED resources in hospitals.

Ethical Issues in the Care of Emerging Adults in Pediatric Intensive Care Units.

Ethical Issues in the Care of Emerging Adults in Pediatric Intensive Care Units.

HOW THE COVID-19 PANDEMIC HAS AFFECTED THE LIVES AND TRAINING OF SURGICAL RESIDENTS IN MAYO HOSPITAL LAHORE

ABSTRACT
 Objective: To assess how the COVID-19 pandemic affects surgical residents in Mayo hospital Lahore in regard to their training and social life.
 Study Design: Observational Study.
 Place and duration of study: Mayo Hospital Lahore, Four months ( May 2020 to August 2020)
 Methodology: A study was conducted using an online questionnaire on Google docs® containing 25 questions to be filled by residents of surgery and allied surgery of Mayo Hospital Lahore. Residents of general surgery and allied surgical departments working during the COVID-19 pandemic were included in the study. SPSS version 26 was used to analyze. A p-value≤of 0.05 was considered significant.
 Results: One hundred and two residents responded to our questionnaire from which 83(81.4%) respondents were male and 19(18.6%) were female. Out of all, 87(85.3%) had a fear of contracting COVID-19. 41(40.2%) get infected with COVID-19 from the hospital and 61(59.8%) remained healthy. In all this scenario of the pandemic of covid-19, 95(93.1%) residents thought that their training suffered a lot during this period as compared to 07(6.9%) residents who think that their training does not suffer significantly during the pandemic. During this pandemic, OPD services were suspended so 79(77.5%) residents had no exposure to a variety of cases, and 75(73.5%) think management in a surgical emergency is up to mark. Regression analysis showed that training of residents affected due to a reduction in bed-side teaching (p-value=0.024), decrease in duty hours (p-value=0.005), and reduction in the number of elective surgeries (p-value=0.045)
 Conclusion: During the pandemic of COVID-19, surgical resident of Mayo hospital had fear of contracting the disease and carrying to their families. Overall they think that their training has been affected by this pandemic due to shut down of outpatient department, elective lists, and bedside teaching in spite of their interest in online teaching.

595-P: CGM Use in Ambulatory Insulin-Treated Patients following Hospital Discharge

Hospitalization is an opportunity for initiation and reevaluation of diabetes management. Many inpatients are either found to have new hyperglycemia or suboptimal glucose control, necessitating the initiation or titration of insulin. Blood glucose monitoring has traditionally been used with insulin therapy. Continuous glucose monitoring (CGM) of interstitial fluid has gained favor as an effective means to achieve this end. We studied the impact of early institution of CGM in the hospital and continuing post-discharge in insulin-treated patients over a 6-month time period. The initiative was shepherded by a newly-established academic endocrinology practice consisting of a diabetes specialist and a nurse clinician. Focused inpatient diabetes teaching, followed by formal outpatient education delivered by certified educators, was employed. 47 patients (31 males, 16 females; average age 63.3 years) were either begun or progressed to intensive insulin therapy (2-4 daily injections), coupled with CGM use (Freestyle Libre or Dexcom G6) within 2 weeks of discharge. Patients used blood glucose meter readings as needed. Downloaded CGM data with ambulatory glucose profile was reviewed for each patient proactively at least once a month. Patients were advised of changes in insulin/diabetes therapy by phone or electronic portal, and during telehealth and in-person office visits. The average time-in-range (TIR) increased from 59.6% to 60.9% (p= 0.5), while the average hemoglobin A1c decreased from an inpatient value of 9.8% to 7.4% (p<0.05) over a mean period of 6 months. The CGM continuation rate was close to 100%. We conclude that with availability of expertise and clinical support, CGM and its interactive technology offers a unique tool to improve glucose control and empower insulin-treated outpatients in the critical post-hospitalization time. It would be expected to result in better outcomes with regard to complications, readmission rates, and cost of care. Disclosure A. A. Rizvi: None. C. Eberlein: None.

Abstract P139: The Impact Of Inpatient Diet Orders On Patient Nutrition And Dietary Behaviors Post Discharge

Introduction: Suboptimal nutrition is a known contributor to the development of cardiovascular disease. In the past decade, focus has been on improving the quality of hospital food with nutrition and policy science initiating programs, e.g. Healthy Food in Health Care. Little has been studied on the impact of these improvements on diet choices after discharge. To our knowledge, this is the first study to evaluate if inpatient diet orders play a role in nutrition after discharge. Methods: Patients ≥18 years of age admitted to the medicine service with either a regular or cardiac diet order were recruited. Exclusion criteria were the following dietary parameters—fluid restriction, low potassium, diabetic, gluten free, or vegan diets. Patients were given a baseline questionnaire using a Lickert scale to assess dietary behaviors, nutrition counseling during admission, and demographics. One month post-discharge, a follow-up questionnaire was given to reassess their dietary choices. Results: In this preliminary analysis, 70 subjects were enrolled: 57.1% (n= 40) regular diet and 42.0% (n=30) cardiac diet. 38.6% (n=27) believed diet orders during admission were part of the their medical treatment. At follow-up, 55 patients remained and included in the final analysis. 50 with identifiable subject IDs: 57.4% (n= 27) regular diet and 42.5% (n=20) cardiac diet. 15 were lost to follow up: 1 deceased, 2 declined to participate, 2 were readmitted to the hospital, and the remaining were not reachable. Diet was reported as always important to overall health 50.0% (n=35) at baseline vs 72.7% (n=40, p= 0.642) at follow up. 22.8% (n=16) of subjects stated never reading nutrition labels in comparison to follow-up 12.7% (n=7, p= 0.019). Never monitoring salt intake was reported among 23.6% (n=9) patients at baseline and 12.7% at follow-up (n=6, p=0.043). Subjects reported that nutrition education was never received during their inpatient or outpatient follow up period (30% (n=21) vs 76.3% (n=42), p=0.0002). Conclusions: To-date, our pilot study shows inpatient diet orders having the potential to influence dietary behaviors with significant changes in food label reading and monitoring salt intake after discharge. Nutrition education was significantly never given in both inpatient and outpatient settings. However, most patients believe nutrition is important to their overall health, further supporting receptivity to nutrition education during inpatient and outpatient follow-up education.

Twelve tips for teaching and supervising post-graduate trainees in clinic

By providing quality teaching and supervision, medical educators can contribute to productive and fulfilling outpatient experiences for postgraduate trainees (sometimes called residents, registrars, or GP trainees). The recent literature addressing practical steps to improve outpatient teaching is limited. Here we present specific trainee-centric behaviors, techniques, and language that educators can employ to enhance their teaching in the outpatient clinic, in the form of twelve tips. The first two tips pertain to navigating the patient-trainee-supervisor dynamic in the exam room, the next four address listening to an oral presentation, and the last six are tips on being an effective teacher and coach.

Medical Graduates’ Viewpoints on the First Big UME Reform in Iran

Background: Shahid Beheshti General Medical Degree Curriculum (2004) is the first big reform program in Iran with more than 10 major educational interventions. Objectives: We aimed to evaluate the graduates’ viewpoints about the program. Methods: This study is a descriptive cross-sectional graduate survey in 2018, in which 194 medical graduates from 2011 to 2014 participated with a response rate of 51.3%. The authors prepared a questionnaire with a four-point Likert scale based on the stakeholders’ viewpoints. The questionnaire contained 121 questions in seven domains: Job status, undertaking social responsibility, self-improvement, competency, effects of interventions, adequacy of educational facilities, the impact of faculty members, and reform book effectiveness. In data analysis, the authors combined the positive ratings of "I agree" and "I strongly agree" and negative ratings of "I disagree" and "I strongly disagree.” Results: More than 88% of the respondents were specialists, medical residents, or were preparing for the medical residency entrance exam. More than 94% of the graduates evaluated themselves as competent in clinical skills, health promotion, and self-improvement, but 48.9% were competent in health advocacy, 43.3% in rehabilitation, 38.6% in the knowledge of diseases, and 29.4% in cognitive skills. The organ system approach (99%) and the approach to the presentation (87.1%) were the most favorable aspects of the program; but, communication skills education (60.8%), problem-solving sessions (64.3%), and professionalism education (66%) were the weak aspects. Bedside clinical teaching (83%) was more effective than outpatient education (79.4%) and didactic education (74.2%). Among the participants, 64.4% assessed the educational facilities as desirable, and 78.4% of them, the educational hours. Besides, 77.8% of the respondents agreed with the positive effect of clinical faculty members, and 45.9% agreed with the basic faculty members. Moreover, a difference was observed between the effects of student textbooks (80.4%) and study guides (60.3%) on enhancing students' learning. Conclusions: Overall, the program has shown effectiveness in many areas; however, it has a few weaknesses that should be considered in curriculum revision.

Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed?

While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.

Outpatient Teaching and Feedback Skills Workshop for Resident Physicians.

IntroductionThere is a need for innovative workshops designed to teach students and residents the basics of clinical medical education. Resident physicians often spend a significant portion of their training teaching others and frequently have very little formal instruction on teaching techniques. Other teaching tools exist but are often either entirely lecture based or too extensive to easily incorporate into a residency teaching session. There is a need for the facilitated practice of teaching methods to improve the resident educational experience.MethodsThis 80-minute workshop blends interactive role-play case studies with quick lectures on the ARCH feedback model, the RIME model of medical information mastery, and the One-Minute Preceptor. This workshop includes three short PowerPoint lectures, four case studies, a handout, a pre-/posttest, and a session evaluation form.ResultsResident and student learners were engaged for the entirety of this session. Pre-/posttest results showed an improvement in understanding of basic teaching and feedback techniques, and survey results showed a higher likelihood of the learners wanting to incorporate teaching into their future practice.DiscussionThis workshop is quick and overall quite effective in teaching basic feedback and teaching techniques. It provides a much-needed opportunity for residents to practice teaching techniques immediately after they have learned the concepts. This training is ideal for a residency program looking to provide new senior residents with the teaching tools they need for success.

Outpatient learning perspectives at a UK hospital.

Undergraduate students spend much of their training in the clinical workplace, increasingly in hospital outpatient settings; however, they report that this does not always yield the educational value that they expect. This study investigates ways in which outpatient learning can be enhanced from the perspectives of students and teachers, exploring which approaches may be most appropriate in different circumstances. We conducted 14 semi-structured interviews with medical students from one UK medical school and consultants (specialists) at a single teaching hospital. We explored their experiences and perceptions of clinical teaching and learning in this outpatient setting. Transcripts were analysed through a consensual qualitative research approach. An evaluation of established frameworks for outpatient teaching was conducted and strategies were matched to stakeholder needs. A total of 24 core ideas were identified, which were categorised into: individual factors (student, doctor and patient), interpersonal factors, team factors and organisational factors. Teaching strategies that address stakeholder needs included: student-led clinics, case-based discussions, one-minute preceptor, the SNAPPS tool (summarize, narrow differential, analyse, probe preceptor, plan and select issues for self-learning), advanced organisers and supplementing. There is a complex interplay between personal, interpersonal, team and organisational factors that contribute to the effectiveness of the outpatient setting as a learning environment. Strategies at the personal and interpersonal levels are unlikely to be successful or sustained without organisational resourcing and support. Further research is needed to implement and evaluate these suggested strategies.

The Prescribing and Education of Naloxone in a Large Academic Medical Center.

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

Determining the rate of achievement of outpatient education standards in major departments of Shiraz medical school from interns' viewpoints, based on ministry's clinical education standards in 2018-2019.

INTRODUCTION:In order to improve outpatient education, it is necessary to carry out formative standard evaluation to reveal the strengths and weaknesses to improve planning the quality of clinical education. Due to numerous challenges in clinical education, the present study was conducted to determine the extent to which outpatient education standards were achieved in the major departments of Shiraz Medical School.METHODS:In this quantitative combined, cross-sectional and practical investigation in the academic year 2018–2019, 178 interns who had passed the outpatient education in the four major wards (internal medicine, pediatrics, gynecology, and surgery) in Shiraz Medical School were randomly selected. A 26-item researcher-made questionnaire, based on the Handbook of the Ministry of Clinical Education (Outpatient Education) for Health and Medical Education's Criteria and indicators, was used in three areas of preparation, timing and implementation; and the psychometric properties of the questionnaire were determined. For quantitative data analysis, SPSS version 22 was used. Furthermore, we performed a qualitative study through semi-structured interviews with 16 interns and analyzed the data using MAXQDA 10 software.RESULTS:The results of the quantitative study showed that 8.4% of interns evaluated the program as poor, 66.3% moderate, and 25.3% good. The qualitative study showed that number and diversity of patients, instructor's educational model, and number of interns had a significant role.CONCLUSION:Although the outpatient teaching in the four major departments of Shiraz Medical School was evaluated relatively acceptable, it is far from the ideal point and need to be improved.

Factors related to advance care planning among older African American women: Age, medication, and acute care visits.

Advance care planning (ACP) is linked with high-quality clinical outcomes at the end of life. However, ACP engagement is lower among African Americans than among Whites. In this study, we sought to identify correlates of ACP among African American women with multiple chronic conditions for two reasons: (1) African American women with multiple chronic conditions have high risks for serious illnesses, more intensive treatments, and circumstances that may require substitutes' decision-making and (2) identifying correlates of ACP among African American women can help us identify important characteristics to inform ACP outreach and interventions for this group. A cross-sectional survey was conducted with 116 African American women aged ≥50 years who were recruited from the central area of a mid-western city. On average, participants were 64 years old (SD = 9.42). The majority were not married (78%), had less than a college education (50%), and had an annual income of $15,000 (54%). Their mean numbers of chronic conditions and prescribed medications were 3.31 (SD = 1.25) and 8.75 (SD = 4.42), respectively. Fifty-nine per cent reported having talked with someone about their preferences (informal ACP); only 30% had completed a living will or a power of attorney for healthcare (formal ACP). Logistic regression showed that age, the number of hospitalizations or emergency department visits, and the number of prescription medications were significantly correlated with both informal and formal ACP; other demographic and psychosocial characteristics (the knowledge of ACP, self-efficacy, and trust in the medical system) were not. Results of this study suggest a need for targeted, culturally sensitive outpatient ACP education to promote ACP engagement in older African American women, taking into account age, the severity of chronic conditions, and levels of medication management.

Return on investment of self-management education and home visits for children with asthma

Objective Priorities of the Centers for Disease Control and Prevention’s 6|18 Initiative include outpatient asthma self-management education (ASME) and home-based asthma visits (home visit) as interventions for children with poorly-controlled asthma. ASME and home visit intervention programs are currently not widely available. This project was to assess the economic sustainability of these programs for state asthma control programs reimbursed by Medicaid. Methods We used a simulation model based on parameters from the literature and Medicaid claims, controlling for regression to the mean. We modeled scenarios under various selection criteria based on healthcare utilization and age to forecast the return on investment (ROI) using data from New York. The resulting tool is available in Excel or Python. Results Our model projected health improvement and cost savings for all simulated interventions. Compared against home visits alone, the simulated ASME alone intervention had a higher ROI for all healthcare utilization and age scenarios. Savings were primarily highest in simulated program participants who had two or more asthma-related emergency department visits or one inpatient visit compared to those participants who had one or more asthma-related emergency department visits. Segmenting the selection criteria by age did not significantly change the results. Conclusions This model forecasts reduced healthcare costs and improved health outcomes as a result of ASME and home visits for children with high urgent healthcare utilization (more than two emergency department visits or one inpatient hospitalization) for asthma. Utilizing specific selection criteria, state based asthma control programs can improve health and reduce healthcare costs.

Nurse-delivered outpatient asthma education for children and caregivers: a pilot study to promote shared asthma management

Objectives To assess the feasibility of nurse-delivered asthma education for caregiver/child dyads in a busy clinic setting, and measure the preliminary effectiveness of the intervention. Methods We conducted a pilot study of nurse-delivered asthma education in a busy outpatient clinic. We enrolled a convenience sample of children (7–16 years) with uncontrolled persistent asthma who had a prescription for an inhaled controller medication and public health insurance. After provider visits, nurses taught dyads using picture-based materials, teach-back methods, and colored labels applied to asthma medications. The intervention was repeated at 1-month follow-up. We assessed feasibility by reviewing nurse documentation in the electronic medical record, detailing whether each component was implemented and the time required for education at each visit. We measured preliminary effectiveness by surveying children and caregivers separately before each clinic visit about asthma management responsibility, self-efficacy, caregiver quality of life, and symptoms; caregivers also completed a final telephone survey 2 months after the follow-up visit. We examined pre-post differences in continuous outcomes within-subjects using Wilcoxon signed rank tests. Results We enrolled 22 child/caregiver dyads. Nursing documentation indicated a high rate of component delivery at each visit; the initial and 1-month visits required 25 and 15 min, respectively. We observed significant increases in child responsibility, child/caregiver self-efficacy, caregiver quality of life, and child symptoms at each follow-up. Conclusion This intervention of patient-centered asthma education can be delivered by nurses to caregiver/child dyads with high fidelity in a busy pediatric practice. Preliminary data indicate potential benefit for both children and caregivers.

Restructuring the final year of the model study programme MaReCuM at the Medical Faculty Mannheim: the academic quarter in ambulatory medicine.

Introduction: To reflect the ever-growing importance of outpatient care in medical education, MaReCuM – a reformed curriculum, also referred to as a model study programme – was introduced at the Medical Faculty Mannheim in 2006. It divided the final year of medical study into quarters and added a mandatory quarter dedicated to ambulatory medicine. This project report presents our experiences, the costs and the evaluation results connected with making specific changes to the final year of undergraduate medical study.Project description: The final-year quarter in ambulatory medicine, taught at the Medical Faculty’s outpatient teaching placements, allows final-year medical students to gather practical experience in one of four elective areas in outpatient care. The parallel coursework encompasses interactive case presentations and practical reviews. Relevant curricular content on ambulatory medicine is then tested in the oral/practical section of the M3 medical examination.Results: Students are very satisfied with the academic quality of the final-year quarter in ambulatory medicine. Restructuring the final year, generating the concept and recruiting teaching placements at outpatient facilities required additional full-time positions in the beginning.Discussion: The processes of reforming MaReCuM have not only contributed to a stronger recognition of ambulatory medicine in the final year and in the clinical phase of study, but have also enabled broader opportunities for focussing individual choices during medical education. A high caliber of academics in the quarter in ambulatory medicine can be achieved with a calculable amount of organisational effort.Conclusion: Anchoring a curriculum on ambulatory medicine in medical education is possible through restructuring the final year and is received positively by students. The success of MaReCuM demonstrates the feasibility of the recommendations made by the German Council of Science and Humanities (Wissenschaftsrat).

Barriers to outpatient education for medical students: a narrative review.

ObjectivesThis study surveys medical education literature published over the last 25 years (1993–2018) to identify the factors scholars consider deleterious to outpatient teaching for medical students. MethodsThis study conducts a review of medical education literature published between 1993 and 2018 using Medline, Lilacs, Ibecs, Cochrane Library, and Scielo databases. The following search terms were utilized: “Education, Medical, Undergraduate” AND “Ambulatory Care” AND “Teaching/methods” OR “Clinical Clerkship” OR “Preceptorship.” This study focuses on papers describing deleterious factors for outpatient teaching with medical students and analyzes their results, discussions, and conclusions sections. ResultsOf the 363 articles obtained, this study selected 33 for analysis. These papers identify numerous factors as barriers to outpatient education. For didactic purposes, these factors are categorized into four barrier groups: environment-institution, academic staff, students, and patients. Academic staff-related teaching barrier was the most frequently mentioned obstacle. Intense care schedule with little teaching time was considered the most common and relevant barrier to outpatient medical education, followed by inappropriate teaching environment and inadequate supervision model. ConclusionsThere is a lack of recent literature on studies focusing on barriers to effective outpatient medical education. Factors identified as harmful to outpatient education have been pointed out by course directors, academic staff, and students in the literature. However, many of these factors remain overlooked by educators, who can use these factors to modify their academic activities for more effective results.

Inpatient Diabetes Education in the Real World: an Overview of Guidelines and Delivery Models.

Diabetes self-management education and support improves diabetes-related outcomes, yet less than 50% of persons with diabetes in the USA receive this service. Hospital admissions present a critical opportunity for providing diabetes education. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. As diabetes rates continue to soar and adults with diabetes continue to have high hospitalization and readmission rates, hospitals face challenges in assessing and meeting diabetes patients' educational needs. The consensus recommendation for inpatient diabetes teaching is to provide survival skills education to enable safe self-management following discharge until more comprehensive outpatient education can be provided. Established and emerging models for delivery of diabetes survival skills education in the hospital may be broadly grouped as diabetes-specialty care models, diabetes non-specialty care models, and technology-supported diabetes education. These models are often shaped by the availability of diabetes specialists, including endocrinologists and diabetes educators-or lack thereof, and staffing resources for provision of services. Recent studies suggest that all three approaches can be deployed successfully if well planned. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. The authors seek to make the reader aware of the heterogeneous approaches that are being implemented nationwide for inpatient diabetes education delivery. Meeting inpatient diabetes educational needs will require a sustained effort, diverse strategies based on resources available, and additional research to explore the impact of these strategies on outcomes.

Reflection and suggestions on teaching and assessment model for standardized residency training of general practitioners

A well-established residency standardized training system is crucial for cultivating qualified general practitioners (GPs) . The syllabus has regulated the goals, objectives, contents and forms of training, but not proposed the concrete and effective teaching and assessment models. This article reflects the existing problems in GP training regarding teaching faculty, rotation plan, outpatient teaching, feedback and evaluation mechanisms as well as the assessment methods and contents, the article also gives specific suggestions for future improvement in order to train competent GPs. Key words: General practitioner; Standardized training; Teaching; Assessment