scholarly journals P110: Are there differences in student academic and clinical performance after rotations at tertiary or community care Emergency Medicine teaching sites?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S103-S104
Author(s):  
C. Rotenberg ◽  
S. Field
Keyword(s):  
Emergency Medicine ◽  
Student Perceptions ◽  
Clinical Performance ◽  
Tertiary Care ◽  
Pass Rate ◽  
Medical Emergency ◽  
Community Hospitals ◽  
Undergraduate Medical Students ◽  
Clinical Scenarios ◽  
Significant Difference

Introduction: Canadian undergraduate medical Emergency Medicine (EM) rotations are often completed at either tertiary care centres or regional community hospitals. While the latter offer students exposure to different practice settings and population needs, many students perceive that teaching at tertiary care EM departments is superior to that in community hospitals. At our institution, third year undergraduate medical students complete three-week EM rotation at either a tertiary centre or a community hospital. We compared academic and clinical performance between students trained in tertiary care centres and students trained in community hospitals. Methods: Academic and clinical performance in EM was evaluated based on the results of an EM-specific multiple choice examination (MCQE) and an annual Objective Structured Clinical Exam (OSCE) assessing competency in a broad range of clinical scenarios commonly addressed in EM. The 40-question MCQE is administered quarterly and a mix of old and new questions are used to ensure consistency. The OSCE is administered annually and relies on the same principal to remain consistent. OSCE scores are binary: pass or fail. We reviewed MCQE and OSCE scores from three consecutive cohorts of students. Students were pooled into two groups, tertiary and community, based on the site of their EM rotation. Mean MCQE and OSCE performance were compared between the two groups of students using two-tailed unpaired T tests. Chi squared tests were used to identify significant differences in scores between cohorts. Results: MCQE and OSCE scores from 312 students over three consecutive cohorts were analyzed. Cohorts included 104, 100, and 108 students with 61% trained in tertiary centres (N = 191). Students trained in tertiary centres had a mean MCQE score of 77%. Students from community centres had a mean score of 78%. There was no significant difference in MCQE scores between tertiary- and community-trained students (p = 0.6099). The OSCE pass rate was 97% for students trained in tertiary centres and 98% for students trained in community centres. OSCE pass rates were not significantly different between the two groups (p = 0.8145). Conclusion: Despite student perceptions that training in tertiary care EM centres was superior, objective analysis showed that academic and clinical performance were similar regardless of training site.

scholarly journals Need for teleconsultation among the emergency medicine and critical care personnel during pre-hospital transport in a tertiary care unit

2017 ◽  
Vol 4 (1) ◽  
pp. 176
Author(s):  
V. Karunai Kadhir ◽  
T. Hemalatha ◽  
V. P. Chandrasekaran
Keyword(s):  
Emergency Medicine ◽  
Treatment Guidelines ◽  
Improve Patient Safety ◽  
Prehospital Care ◽  
Tertiary Care ◽  
Minimum Time ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference ◽  
Time Required

Background: Time being the most crucial factors in emergency medicine, teleconsultation enables patient assessment by specialists, immediate reception of appropriate treatment guidelines until the patient's arrival at hospital.Methods: Our study evaluated the need for teleconsultation among the emergency physicians (EP) and emergency technicians (ET) in a tertiary care hospital. Cross-sectional study conducted in Department of Emergency Medicine, a tertiary care setting. Pretested semi-structured questionnaire was given to EP and ET. Various parameters like the need for teleconsultation, the minimum time required for EMS (emergency medical services) to arrive at the scene and to the hospital, effectiveness of teleconsultation in prehospital care were evaluated.Results: SPSS version 18.0 was used. 24 EP and 36 ET participated in the study. The minimum time required for the EMS to arrive at the scene and then to hospital was calculated indirectly to be > 30 min. There was a significant difference among the EP an ET in interpreting common emergency condition p = 0.029 and criticality assessment p=0.035.The training of EMS staffs was adequate. Both EP and ET were able to adhere recent guidelines during prehospital transport. All the study participants (100%) felt the need for teleconsultation which would improve the patient management during the prehospital period.Conclusions: Teleconsultation has the potential to improve patient safety and quality of treatment in a prehospital setting and should be further evaluated.  

scholarly journals Blended teaching versus traditional teaching for undergraduate physiotherapy students at the University of the Witwatersrand

2021 ◽  
Vol 77 (1) ◽  
Author(s):  
Sadiya Ravat ◽  
Paula Barnard-Ashton ◽  
Monique M. Keller
Keyword(s):  
Blended Learning ◽  
Student Perceptions ◽  
Clinical Performance ◽  
Performance Outcomes ◽  
Health Science ◽  
Cross Sectional ◽  
Face To Face ◽  
Significant Difference ◽  
Physiotherapy Students ◽  
Blended Teaching

Background: Shifting from face-to-face teaching to incorporating technology may prepare students better for future work as health professionals. Evidence of blended teaching’s effect on the academic performance of undergraduate physiotherapy students’ performance is scarce.Objective: The purpose of our study was to determine students’ theoretical and clinical performance in a blended teaching module compared to their own performance in two knowledge areas taught face to face, and student perceptions of blended teaching in the third-year physiotherapy curriculum.Methods: The cross-sectional study design included 47 third-year physiotherapy students. The orthopaedic module was delivered using a blended teaching approach in two consecutive semesters, whilst two other physiotherapy knowledge areas, neuromusculoskeletal and cardiopulmonary, in the same semesters were delivered face to face. Theoretical and clinical performances of students were compared for significance and effect. Students were assessed on their theoretical and clinical knowledge in all areas using the same assessment methods. The students (n = 43) also completed a survey on their blended teaching experience.Results: Significantly higher theoretical marks for orthopaedics were calculated compared to neuromusculoskeletal and cardiopulmonary for both semesters with a large positive effect (average Cohen d = 4.44) for blended teaching on theoretical examination performance; no statistically significant difference for clinical performances. Students felt engaged in the blended teaching process, and 72% preferred blended teaching over face-to-face teaching or online delivery.Conclusion: Blended teaching improved the theoretical marks, demonstrating that knowledge acquisition was improved, but not clinical performance.Clinical implications: The study contributes to the knowledge base of blended learning in Health Science Education in South Africa. The authors identified a gap where future studies should investigate the effect of blended learning on clinical performance outcomes as a continuation from this one.

scholarly journals A smartphone use and its impact on academic performance of medical students: a cross sectional study

2021 ◽  
Vol 8 (10) ◽  
pp. 1582
Author(s):  
Praveen Kumar R. S. ◽  
Kaki Aruna ◽  
Aravind Kumar ◽  
Venkatalakshmi P.
Keyword(s):  
Academic Performance ◽  
Medical Students ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Steady Increase ◽  
Sectional Study ◽  
Undergraduate Medical Students ◽  
Cross Sectional ◽  
Significant Difference ◽  
Smartphone Use

Background: Smartphones are unavoidable technology in this modern era. Though there are several advantages with the use of smartphones, there is another school of thought is that due to excessive use of smartphones and addiction behavior the academic performance of the students gets deteriorates. With this in background, this study was conducted to compare the use of smartphones with the student’s academic performances.Methods: This prospective cross-sectional study was conducted among the undergraduate medical students of Sri Venkateshwara medical college hospital and research institute, Puducherry, a tertiary care teaching hospital during the January 2019 to July 2019. A total of 370 students were included in this study. All were assessed for the demographic profile and questions related to usage of smart phones using a questionnaire. Data was analyzed using SPSS.Results: Sharing documents, assessing drug information, taking notes and reading journals articles and books was the academic reasons reported by 94.6%, 72.7%, 58.1% and 35.7% of participants, respectively. Among non-academic reasons games, social media and entertainments was recorded in 82.4% 75.4% and 33% of participants, respectively. Mean duration of smart phone usage in a day was 3.5 hours. However, there was no significant difference noted between the academic performance and use of smartphones.Conclusions: Though smartphone use has no significant impact on academic performance of medical students, with the view of steady increase in smartphone usage, there is a necessary for further monitoring, in order to prevent smartphone related complications like addiction.

scholarly journals P129: The impact of high performance physician training on resident wellness and clinical performance

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S121-S121
Author(s):  
P. Sytnik ◽  
A. Hussain ◽  
J. Brooks
Keyword(s):  
Emergency Medicine ◽  
High Performance ◽  
Situational Awareness ◽  
Performance Enhancement ◽  
Clinical Performance ◽  
Maslach Burnout Inventory ◽  
Significant Difference ◽  
Resident Wellness ◽  
The Impact ◽  
Domain Scores

Introduction / Innovation Concept: There are numerous research studies in the medical literature, which demonstrate how the experience of a medical residency can contribute towards burnout. The escalating performance pressures and expectations during residency training have the potential to negatively impact upon physician health and clinical performance. The purpose of this prospective cohort study was to test the effectiveness of the High Performance Physician (HPP) program among General Surgery residents at the University of Manitoba with regard to burnout and clinical performance. Methods: This program was delivered over a 9-week period. All 26 residents were asked to complete the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Each resident then participated as the team leader for a 15-minute trauma resuscitation simulation. Three attending physicians from Surgery & Emergency Medicine assessed resident performance and ability to manage work-based stressors. Following the simulation, each resident received a debrief interview. Once the HPP curriculum had been completed, residents took part in a second high fidelity simulation session and again completed the MBI-HSS. Curriculum, Tool, or Material: The HPP program offered through the Department of Emergency Medicine (EM), is a performance enhancement based curriculum. It is designed to equip physicians with mental skills to help optimize focus, arousal control, stress management, communication, and teamwork. Further, to utilize these skills to cope and respond more effectively to the inherent performance pressures that may present within one’s area of specialization. Conclusion: The Emotional Exhaustion domain of the MBI-HSS demonstrated a statistically significant decrease. The other domain scores were not statistically significant. Simulation domain scores did not demonstrate a statistically significant difference in performance between the pre- and post-HPP curriculum simulation sessions. A summative content analysis of the interview data demonstrated that residents believed internal barriers to situational awareness were the most significant impact on performance. Further study is required to determine if differences are seen in long-term follow-up.

scholarly journals VARIABILITY IN EMERGENT MANAGEMENT OF DIABETIC KETOACIDOSIS IN PEDIATRICS: A RETROSPECTIVE CHART REVIEW

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e11-e12
Author(s):  
Zoyah Thawer ◽  
David Saleh ◽  
Keith Gregoire
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Insulin Infusion ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Evidence Based ◽  
Community Hospitals ◽  
Tertiary Centre ◽  
Paediatric Patients ◽  
Significant Difference

Abstract BACKGROUND Variability in the management of paediatric diabetic ketoacidosis (DKA) has been well described in the literature. Although there are many paediatric DKA management guidelines available at tertiary care centres, there seems to be a lack of familiarity with these in some community hospitals, leading to management inconsistent with evidence-based clinical practice. OBJECTIVES Our objectives were to review the management of paediatric patients who present in DKA, identify those that received initial emergent treatment not consistent with current guidelines, and track associated complications. DESIGN/METHODS Forty-seven charts of paediatric patients admitted to our institution (including patients transferred from peripheral hospitals) from January, 2012 to July, 2017 were identified by ICD-10 codes containing “ketoacidosis”. Primary outcome measures for inadequate management included major risk factors for cerebral edema - IV insulin boluses, IV bicarbonate boluses, hypo-osmolar IV fluid administration and non-NPO status - as well as inappropriate IV fluid boluses>10mL/kg, insulin infusion initiated within the first hour after IV fluids were initiated, and inadequate potassium replacement. RESULTS At least one area of inadequate management occurred at a rate of 74.5% with no significant difference between community hospitals and our tertiary centre. The most common parameter was inadequate replacement of potassium (44.7%), followed by receiving an IV fluid bolus>10mL/kg (40.4%). Twenty-three percent of patients received inadequate management that included a treatment-related major risk factor for cerebral edema. The most common complication was hypoglycemia (BG<4.0mM; 14.9%) and there were no cases of cerebral edema or patients that received a CT head. Though the mean time to insulin infusion initiation was 4.0 hours at outside centres and 2.8 hours at our tertiary centre, the difference was not statistically significant (p=0.26). However, there was a statistically significant difference in time to correction of acidosis, with correction of DKA happening more quickly at our tertiary centre (9.5h compared to 12.7h at outside centres; p=0.03). CONCLUSION Optimal paediatric DKA management continues to be a challenge despite the presence of multiple, evidence-based guidelines. Gradual resuscitation with appropriate fluids appears to be the most common area in which variability exists in community and tertiary care centres.

scholarly journals Comparative assessment of antibiotic resistance among first and second year undergraduate medical students in a tertiary care teaching hospital

2019 ◽  
Vol 7 (2) ◽  
pp. 481 ◽  
Author(s):  
Rohini Gupta ◽  
Apoorva Malhotra ◽  
Pavan Malhotra
Keyword(s):  
Antibiotic Resistance ◽  
Medical Students ◽  
Antimicrobial Resistance ◽  
Tertiary Care ◽  
First Year ◽  
Undergraduate Medical Students ◽  
Future Health ◽  
Cross Sectional ◽  
Significant Difference ◽  
Second Year

Background: Antibiotics are one of the commonest prescribing drugs in day to day practice. However indiscriminate and irrational use of antibiotics has given rise to the emergence of antibiotic resistance. Thus, intervention in the form of educating students and making them aware about this important concept should be initiated at the gross root level right from the beginning of medical profession. Objective was to assess the comparative awareness regarding antimicrobial resistance between first and second year MBBS students.Methods: This was a comparative, cross-sectional questionnaire based study. Two forty six undergraduate medical students, 118 students from 1st year and 129 students from 2nd year MBBS were included in the study to assess the extent of knowledge and about the problem of antibiotic resistance. Self-administered questionnaire was used to collect the data from respondents. The questionnaires of both the groups were analyzed for the responses of the students and were compared using student ‘t’ test and chi-square test.Results: Majority of the participants 63.6% and 72.9% had completed the full course of antibiotics as prescribed by the physician. Statistically significant difference (p<0.05) was found between the two groups where in 58.4% of the first year and 16.3% of the second year students were of the view that antibiotics can be used for viral illnesses. Only 44.1% students of first year knew the reasons for antibiotic resistance.Conclusions: It can be concluded from the present study that second year medical students were more aware regarding antimicrobial resistance as compared to first year MBBS students who represented the general public. Thus, it is very important to educate the students in a practical manner about this concept as they are the future health care givers who can promote the rational use of antibiotics in near future.

Association of Rugae Pattern with Skeletal Malocclusion in Orthodontic Patients Visiting Tertiary Care Hospital

2020 ◽  
Author(s):  
Sarwat Memon
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Class Iii ◽  
Chi Square ◽  
Cross Sectional ◽  
Skeletal Malocclusion ◽  
Palatal Rugae ◽  
Significant Difference ◽  
Orthodontic Patients

Background: The palatal rugae are special constructions that are inalterable in their position and pattern during the lifestyles of an individual. This imparts them an exceptional role in the forensic dentistry and may play potential role in malocclusion identification. This study was aimed to see association of rugae pattern with sagittal skeletal malocclusion in orthodontic patients visiting tertiary care hospital. Methods: This cross-sectional examination was completed on pretreatment records (lateral Cephalometric radiographs and maxillary dental casts) of 384 subjects at the orthodontic department of Ziauddin Dental Hospital, Karachi. The study duration was from January to July 2019. The samples were sub-divided into three sagittal skeletal groups based on ANB angle proposed by Steiner’s on lateral Cephalometric radiographs (Class I with ANB angle between 0° to 4°; Class II: ANB angle greater than 5°; Class III: ANB angle less than 0°). The shapes of three most-anterior primary rugae were then evaluated bilaterally using Kapali et al., Classification. Chi Square test was applied to find association of rugae pattern among sagittal skeletal malocclusions groups. Results: Circular and curved rugae shapes were the most prevalent in all skeletal malocclusions. The primary palatal rugae pattern was seen to be significantly different among three skeletal malocclusion groups (p<0.05). The right and left sided palatal rugae pattern showed significant difference in all three skeletal malocclusion groups (p<0.05). Conclusion: The present study showed no specific palatal rugae pattern associated with sagittal skeletal malocclusion. Further studies on larger sample and use of modern 3D technologies to scan the maxillary casts are required for results that are more precise.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

2019 ◽  
Vol 10 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Tristan B. Weir ◽  
Neil Sardesai ◽  
Julio J. Jauregui ◽  
Ehsan Jazini ◽  
Michael J. Sokolow ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Linear Regression Analysis ◽  
Degenerative Spondylolisthesis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Hospitals ◽  
Single Level ◽  
Significant Difference ◽  
Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

2020 ◽  
pp. 1-6
Author(s):  
P. Dubey ◽  
J. Shrivastava ◽  
B.P. Choubey ◽  
A. Agrawal ◽  
V. Thakur
Keyword(s):  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neurodevelopmental Outcome ◽  
Significant Risk ◽  
Central India ◽  
Significant Risk Factor ◽  
Motor Domain ◽  
Medical Emergency ◽  
One Year ◽  
Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

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