Patient Care Scenario Research Articles

Impact of teaching modality on soft skill development: Oral health literacy awareness skills assessed using standardized patient experiences.

Health literacy awareness is a crucial skill for health professionals, yet training may be lacking. Didactic lectures may improve health literacy awareness in future health professionals, however, compressed curricula may lead educators to consider the incorporation of eLearning into the delivery of health literacy education. E-modules have been shown to engage learners, yet little is known about their effectiveness in instilling behavioral change in learners' clinical communication skills. This study aimed to shed light on the impact of learning modality on dental students' ability to learn and translate soft skills into clinical settings. An e-module on health literacy awareness was created by the researchers with an equivalent lecture developed. Fifty-six dental students were randomly assigned to a control or intervention cohort (lecture or e-module) and all cohorts participated in standardized patient experiences to be assessed in a simulated but authentic patient care scenario. Pre- and post-intervention scores, simulation scores, and learner reflections were compared. Fifty-six students participated in the study. Post-intervention health literacy awareness knowledge increased for both intervention cohorts. In clinical simulation, intervention cohorts scored significantly higher on nearly all variables, with the lecture cohort scoring consistently better than e-learners. Both lecture and e-learning are effective learning modalities for promoting health literacy awareness, but dental students learning the subject via lecture may translate certain newly acquired soft skills more effectively in clinical scenarios.

Framing our Expectations: Variability in Entrustable Professional Activity Assessments

To determine the ability of surgical trainees and faculty to correctly interpret entrustability of a resident learner in a modeled patient care scenario. Prospective study utilizing a web-based survey including 4 previously-recorded short videos of resident learners targeted to specific levels of the American Board of Surgery's (ABS) Entrustment Scale. Respondents were asked to choose the entrustment level that best corresponded to their observations of the learner in the video. Responses were subcategorized by low and high entrustment. Online, utilizing the Qualtrics survey platform. Survey targeting US surgical trainees and surgical faculty via email and social media. We received 31 complete responses and 2 responses which completed > 1 video assessment question without demographic information (n = 33). Respondents included 10 trainees (32%) and 21 attending surgeons (68%). Neither faculty nor trainees readily identified the targeted entrustment level for Question 1 (preoperative care of a patient with acute appendicitis with high entrustment, 36% correct), though evaluations of the remaining questions (2 through 4) demonstrated more accuracy (70, 84, and 75% correct, respectively). Faculty were more readily able than trainees to identify low entrustment (level Limited Participation) in intraoperative inguinal hernia repair (95% vs 60%, p = 0.03). After subcategorization to high and low entrustment, both residents and faculty were able to accurately identify entrustment 95% overall. Both trainees and attending surgeons were able to identify high- and low-performing residents on short video demonstrations using the ABS EPA entrustment scale. This provides additional evidence in support of the need for frequent observations of EPAs to account for the variability in raters' perceptions in addition to complexity of clinical scenarios. Frame-of-reference training via a video-based platform may also be beneficial for both residents and faculty as an ongoing EPA implementation strategy.

A Quick Guide to Writing a Teaching Case Study.

Case studies published in the Journal of Nuclear Medicine Technology are brief chronologic or logical descriptions of a clinical experience that aim to share a technical outcome associated with an instrumentation or patient care scenario or demonstrate a unique finding associated with a nuclear medicine procedure. Although brief by necessity, case studies provide enough relevant detail to educate the reader about a clinical condition coupled with a diagnostic or therapeutic procedure. Case studies do not have to be about bizarre clinical conditions. Case studies can be about quality issues that directly impact the imaging or therapeutic procedure, protocol modifications when a clinical scenario requires out-of-the-box decisions, new techniques developed to address unique or difficult situations, or something as simple as an artifact that resulted in an unusual image finding. The sections of a case study, including the introduction, case report, discussion, and conclusion, are explained. The goal of this article is to teach new authors how to write a teaching case study.

Learning to Manage De-escalation Through Simulation: An Exploratory Study

BackgroundNurses are increasingly at risk of experiencing physical or verbal violence, during their career. The aim of this study was to explore undergraduate student nurses’ responses to patient aggression in a simulated patient care scenario and to facilitate development of de-escalation management skills. MethodsUsing role-play methodology, 28 third-year nursing students took part in a simulated aggressive patient scenario. Data were drawn from recorded participant debriefing sessions immediately following simulation immersion. ResultsStudents reported a high level of stress and a variety of emotive responses. They identified new insights into strategies that could be used to defuse volatile situations in their future practice and highlighted that the use of a standardized patient enhanced the authenticity of the experience. ConclusionsFacing verbal aggression is confronting for nursing students. Practicing and reflecting on de-escalation management strategies, in an authentic simulated safe environment, provided students with an opportunity to gain new insights into their role as nurses while developing effective strategies to draw on in clinical practice.

Relationship between occupational stress injury score and simulated patient-care scenario performance among experienced paramedics.

It is well-known that psychosocial health status of paramedics may be altered by their job demands. However, it is unknown whether psychosocial health status can affect occupational performance. The goal of this study was to explore whether a paramedic's symptom severity of Occupational Stress Injury (OSI) was related to simulated patient-care performance. Nineteen paramedics with 15.0±8.7 years of paramedic experience participated in this study. Participants completed both an OSI symptom severity questionnaires, and a patient-care simulation. Vagal activity was also collected during the patient-care simulation. The simulation was used to assess experienced paramedics in a realistic stressful setting. Based on the provincial standard in New Brunswick, an experienced paramedic instructor graded the patient-care simulation using the provincial standard charts, observing performance videos and assessing data from the manikin. The current study suggests that paramedics who self-reported elevated symptoms of OSI were less likely to successfully complete the simulated patient-care scenario. This research suggests that the presence of self-reported elevated symptoms of OSI negatively impacts paramedics' performance during a stressful work task simulation. Therefore, to help paramedics maintain optimal performance, it may be important to ensure that paramedics have access to appropriate resources to monitor and improve their psychosocial health.

Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol for a Randomized Controlled Trial.

BackgroundGaps between rational thought and actual decisions are increasingly recognized as a reason why people make suboptimal choices in states of heightened emotion, such as stress. These observations may help explain why high-risk medications continue to be prescribed to acutely ill hospitalized older adults despite widely accepted recommendations against these practices. Role playing and other efforts, such as simulation training, have demonstrated benefits to help people avoid decisional gaps but have not been tested to reduce overprescribing of high-risk medications.ObjectiveThis study aims to evaluate the impact of a simulation-based training program designed to address decisional gaps on prescribing of high-risk medications compared with control.MethodsIn this 2-arm pragmatic trial, we are randomizing at least 36 first-year medical resident physicians (ie, interns) who provide care on inpatient general medicine services at a large academic medical center to either intervention (simulation-based training) or control (online educational training). The intervention comprises a 40-minute immersive individual simulation training consisting of a reality-based patient care scenario in a simulated environment at the beginning of their inpatient service rotation. The simulation focuses on 3 types of high-risk medications, including benzodiazepines, antipsychotics, and sedative hypnotics (Z-drugs), in older adults, and is specifically designed to help the physicians identify their reactions and prescribing decisions in stressful situations that are common in the inpatient setting. The simulation scenario is followed by a semistructured debriefing with an expert facilitator. The trial’s primary outcome is the number of medication doses for any of the high-risk medications prescribed by the interns to patients aged 65 years or older who were not taking one of the medications upon admission. Secondary outcomes include prescribing by all providers on the care team, being discharged on 1 of the medications, and prescribing of related medications (eg, melatonin, trazodone), or the medications of interest for the control intervention. These outcomes will be measured using electronic health record data.ResultsRecruitment of interns began on March 29, 2021. Recruitment for the trial ended in Q42021, with follow-up completed by Q12022.ConclusionsThis trial will evaluate the impact of a simulation-based training program designed using behavioral science principles on prescribing of high-risk medications by junior physicians. If the intervention is shown to be effective, this approach could potentially be reproducible by others and for a broader set of behaviors.Trial RegistrationClinicalTrials.gov NCT04668248; https://clinicaltrials.gov/ct2/show/NCT04668248International Registered Report Identifier (IRRID)PRR1-10.2196/31464

Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios.

IntroductionTo evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics.MethodsEMS professionals of a large county‐based system participated in 1 of 4 standardized patient care scenarios. Each 8‐minute scenario included escalated threats of violence such that EMS personnel should escape the scene for safety. Trained evaluators recorded EMS professionals' performance using standardized data elements. Outcomes included EMS personnel escape and verbal de‐escalation attempts. Descriptive statistics and univariable odds ratios (OR) with 95% confidence intervals (95% CI) are reported.ResultsThere were 270 EMS professionals evaluated as individual members of 2‐person crews. Overall, 54% escaped the unsafe scene and 54% made an adequate de‐escalation attempt; 20% did not make an adequate de‐escalation attempt nor escape the unsafe scene. Paramedics demonstrated lower odds of escaping compared to emergency medical technicians (OR: 0.40; 95% CI: 0.17–0.94), yet greater odds of adequate de‐escalation (OR: 3.17, 95% CI: 1.38–7.31). EMS professionals with more than 20 years of experience (OR: 0.32, 95% CI: 0.13–0.79, ref:2 years or less) and those with military experience (OR: 0.37; 95% CI: 0.17–0.81) demonstrated reduced odds of escaping. Crisis intervention team (CIT) training was associated with reduced odds of escape (OR: 0.38; 95% CI: 0.21–0.69), but increased odds of adequate de‐escalation (OR: 2.19; 95% CI: 1.19–4.04).ConclusionsNearly half of EMS professionals did not remove themselves from a simulated patient care scenario with an escalating threat of physical violence. EMS‐specific training for de‐escalation as a first‐line technique, recognizing imminent violence, and leaving a dangerous environment is needed.

Bouncing off Each Other: Experiencing Interprofessional Collaboration Through Simulation

BackgroundEffective communication and collaboration in interprofessional teams are fundamental to the provision of high quality and safe healthcare. The aim of this study was to explore the experiences of interprofessional, pre–qualifying health professional students engaged in a simulated patient care scenario. MethodsStudents from five healthcare disciplines were immersed in a collaborative simulation experience of managing a patient with stroke, from admission to discharge. Three focus groups were used to evaluate students’ experiences. ResultsThree key themes emerged from participant narratives: (a) Learning to Speak the Same language: Working Together to Understand the Healthcare Team, (b) Progressing from Uncertainty to Collaborative Practice: Reflecting on Practice and Transition, and (c) Lessons Learned in Developing the Simulation: Barriers and Enablers to Learning. ConclusionsImmersion of healthcare students in interprofessional simulation experiences enhances role understanding, collaborative decision making, and communication skills.

The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients

ObjectivePatients with obesity may experience less patient-centered care. We assessed whether medical students’ implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity. MethodsThird and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed. ResultsStudent perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=−0.19, p = 0.01), friendliness (b=−0.28, p < 0.001), responsiveness (b=−0.21, p = 0.002), respectfulness (b=−0.17, p = 0.003), interactivity (b=−0.22, p = 0.003), likelihood of being recommended by observers (b=−0.34, p < 0.001), and patient-centeredness index scores (b=−0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=−0.16, p = 0.03), recommendation likelihood (b=−0.22, p = 0.04), and patient-centeredness index score (b=−0.12, p = 0.03). ConclusionsNegative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity. Practice implicationsEfforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.

Silica nanoparticles with encapsulated DNA (SPED) \u2013 a novel surrogate tracer for microbial transmission in healthcare

BackgroundThe increase in antimicrobial resistance is of worldwide concern. Surrogate tracers attempt to simulate microbial transmission by avoiding the infectious risks associated with live organisms. We evaluated silica nanoparticles with encapsulated DNA (SPED) as a new promising surrogate tracer in healthcare.MethodsSPED and Escherichia coli were used to implement three experiments in simulation rooms and a microbiology laboratory in 2017–2018. Experiment 1 investigated the transmission behaviour of SPED in a predefined simulated patient-care scenario. SPED marked with 3 different DNA sequences (SPED1-SPED3) were introduced at 3 different points of the consecutive 13 touch sites of a patient-care scenario that was repeated 3 times, resulting in a total of 288 values. Experiment 2 evaluated SPED behaviour following hand cleaning with water and soap and alcohol-based handrub. Experiment 3 compared transfer dynamics of SPED versus E. coli in a laboratory using a gloved finger touching two consecutive sites on a laminate surface after a first purposefully contaminated site.ResultsExperiment 1: SPED adhesiveness on bare skin after a hand-to-surface exposure was high, leading to a dissemination of SPED1–3 on all consecutive surface materials with a trend of decreasing recovery rates, also reflecting touching patterns in concordance with contaminated fingers versus palms. Experiment 2: Hand washing with soap and water resulted in a SPED reduction of 96%, whereas hand disinfection led to dispersal of SPED from the palm to the back of the hand. Experiment 3: SPED and E. coli concentration decreased in parallel with each transmission step – with SPED showing a trend for less reduction and variability.ConclusionsSPED represent a convenient and safe instrument to simulate pathogen spread by contact transmission simultaneously from an infinite number of sites. They can be further developed as a central asset for successful infection prevention in healthcare.

Evaluating healthcare workers’ hand hygiene performance using first-person view video observation in a standardized patient-care scenario

Monitoring healthcare workers' (HCWs) hand hygiene (HH) performance is recommended for improving compliance. Observer biases challenge data validity, thus supplemental approaches such as video observation are needed to complement monitoring. We investigate first-person view (FPV) video observation during simulated standardized patient care handling a catheter in a study with 71 HCWs. HH performance was evaluated for (1) all HH opportunities and (2) a subset of opportunities required in an ideal work sequence, hereafter core opportunities. HCWs' acceptance of FPV video observation and usability judgments were assessed. Compliance level for core HH opportunities (M = 43.5%) was significantly higher than compliance considering all opportunities (M = 30.4%, t(70) = 8.493, P < .001). Reducing HH opportunities to core opportunities would significantly increase compliance levels from the observed average of 30.4% to 44.9% (t(70) = 12.822, P < .001). Overall, both usability ratings and acceptance of the body camera were promising. FPV video observation in simulated standardized patient care provides new instruments to evaluate HH performance beyond mere compliance rates. Our results emphasize the role of optimizing workflow in order to improve HCW's HH compliance. FPV video observation in a standardized patient care simulation is feasible and offers information for HH interventions that target actual deficiencies.

I178] EANM/EARL harmonization strategies in PET quantification: From daily practice to multicentre oncological studies

Quantitative positron emission tomography (PET-) imaging is essential for staging and tracking subtle processes like pathophysiologic change and therapy response in oncological diseases. The accuracy of PET-quantification decisively depends on the correct system calibration involving all corrections that are implicitly necessary using the full ring PET Detector setting in 3D mode. Basically, these are scatter-, random-, attenuation-, dead-time corrections and detector normalization on a regular basis as a requirement for correct activity quantification, that is, for the true measurement of the activity concentration in a given lesion, focus, organ or phantom. Moreover, activity quantification with PET is influenced by noise and by the method of data analysis/image-reconstruction that determine the contrast recovery and resolution. These requirements and parameters need to be addressed, selected and assessed with particular scrutiny if PET systems are to be used for semi- or fully quantitative outcomes for monitoring disease progression and/or therapy response in patient care and research settings. This is of even more importance if data is pooled across imaging sites and/or advanced methods like invasive or non-invasive pharmacokinetic modeling become increasingly considered for a particular trial. Depending on the intended method of quantification, several metrics are derived from that concentration and/or its course over time in blood and tissue. This talk will focus on the EANM/EARL strategy to harmonize and standardize PET-quantification across centers and, thus, give an insight in practical aspects, outcomes and benefits of an independent regular assessment of the calibration and image quality of hybrid PET systems. Sites and systems that get EARL accredited considerably save time and efforts if it comes to setting up the site and the system for inclusion and PET imaging within a particular trial were quantitative hybrid PET is a major part in reaching the endpoints of the multicenter study. Despite being first and foremost intended for accreditation for research settings, the conduct, design and outcome of the EARL accreditation raises awareness of the centers excellence in the patient care scenario also.

How Well Do Rheumatology Fellows Manage Acute Infusion Reactions? A Pilot Curricular Intervention.

Infusible disease-modifying antirheumatic drugs (DMARDs) are commonly prescribed in rheumatology and other fields. There are no published formal educational curricula that rheumatology fellowship programs can use to teach infusion reaction management skills to fellows. We aimed to better understand this educational gap and implement and assess the effectiveness of an experiential curriculum on acute infusion reaction management. We included current rheumatology fellows and recent graduates from 5 fellowship programs. Using a novel behavioral checklist, we assessed fellows' performance managing an infusion reaction in a simulation, followed by a didactic session focused on infusion reactions. Pre- and postsurveys assessed experiences to determine relevance, as well as attitudes and knowledge. Despite ubiquitous prescribing of infusible biologic DMARDs, >50% of fellows were uncomfortable managing infusion reactions. Only 11% of fellows reported infusion reaction training during fellowship, but 56% reported managing actual patient infusion reactions. In the simulated infusion reaction, fellows managed grade-1 reactions appropriately, but grade-4 reactions poorly, meeting <50% of objectives. All fellows discontinued the infusion in the setting of anaphylaxis, but only 56% administered epinephrine. There was no difference in performance or written knowledge by training year. All fellows felt more prepared to manage infusion reactions postcurriculum and were satisfied with the experience. We confirmed an education gap in rheumatology fellowship training regarding infusion reactions, both in knowledge and performance. We developed and implemented a brief experiential curriculum including simulation of a high-risk patient-care scenario. This curriculum was well received and is easily exportable to other programs.

Using Debates to Mimic Clinical Discussion in Experiential Education

Critical thinking and application of knowledge to an ambiguous patient care scenario are often difficult skills to cultivate in learners. Use of traditional teaching techniques (e.g. topic discussions and journal clubs) helps to develop these competencies within learners. However, alternative teaching strategies may help develop critical thinking and direct application. Debates have been used in healthcare education for decades with positive results. This paper provides supporting evidence for use of debates in pharmacy education and is designed to serve as a general guide for preceptors interested in implementing debates into the experiential setting. Specifically, the objectives are to: 1) highlight the pedagogical outcomes as reported in the literature, 2) offer practical considerations to implement debates as a teaching tool in experiential education, and 3) encourage future research and scholarship in this area.&#x0D; &#x0D; Type: Idea Paper

Defeating information overload in health surveillance using a metacognitive aid innovation from military combat systems

Modern sensors for health surveillance generate high volumes and rates of data that currently overwhelm operational decision-makers. These data are collected with the intention of enabling front-line clinicians to make effective clinical judgments. Ironically, prior human–systems integration (HSI) studies show that the flood of data degrades rather than aids decision-making performance. Health surveillance operations can focus on aggregate changes to population health or on the status of individual people. In the case of clinical monitoring, medical device alarms currently create an information overload situation for front-line clinical workers, such as hospital nurses. Consequently, alarms are often missed or ignored, and an impending patient adverse event may not be recognized in time to prevent crisis. One innovation used to improve decision making in areas of data-rich environments is the Human Alerting and Interruption Logistics (HAIL) technology, which was originally sponsored by the US Office of Naval Research. HAIL delivers metacognitive HSI services that empower end-users to quickly triage interruptions and dynamically manage their multitasking. HAIL informed our development of an experimental prototype that provides a set of context-enabled alarm notification services (without automated alarm filtering) to support users’ metacognition for information triage. This application is called HAIL Clinical Alarm Triage (HAIL-CAT) and was designed and implemented on a smartwatch to support the mobile multitasking of hospital nurses. An empirical study was conducted in a 20-bed virtual hospital with high-fidelity patient simulators. Four teams of four registered nurses (16 in total) participated in a 180-minute simulated patient care scenario. Each nurse was assigned responsibility to care for five simulated patients and high rates of simulated health surveillance data were available from patient monitors, infusion pumps, and a call light system. Thirty alarms per nurse were generated in each 90-minute segment of the data collection sessions, only three of which were clinically important alarms. The within-subjects experimental design included a treatment condition where the nurses used HAIL-CAT on a smartwatch to triage and manage alarms and a control condition without the smartwatch. The results show that, when using the smartwatch, nurses responded three times faster to clinically important and actionable alarms. An analysis of nurse performance also shows no negative effects on their other duties. Subjective results show favorable opinions about utility, usability, training requirement, and adoptability. These positive findings suggest the potential for the HAIL HSI system to be transferrable to the domain of health surveillance to achieve the currently unrealized potential utility of high-volume data.

Minocycline: Rheumatoid Arthritis.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Montelukast: Eosinophilic Esophagitis.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Pyridostigmine: Postpoliomyelitis Syndrome.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Benazepril: Nephropathy (Non-diabetic).

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Fosinopril: HIV-Associated Nephropathy (HIVAN).

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.