ResearchPad - Education https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[How students choose E‐learning resources: The importance of ease, familiarity, and convenience]]> https://www.researchpad.co/product?articleinfo=Ncda92ffc-35a5-48ca-ba42-2d99c401eced <![CDATA[MON-137 Evaluation of the Timeliness of Serial Denosumab Administrations at the University of Colorado Hospital]]> https://www.researchpad.co/product?articleinfo=Nebc5db97-67e3-4098-a8f0-47019a068095

Abstract

BACKGROUND:

Denosumab is an antiresorptive medication commonly used in the treatment of osteoporosis that works by slowing bone loss. This medication should not be delayed or interrupted without initiation of an alternative treatment (i.e. bisphosphonates) as studies have shown that this can lead to rapid bone loss, very high markers of bone turnover, and increased vertebral fracture (VF) risk. It is unknown how frequently dosing is delayed in practice settings and how best practices can ensure timely dosing. Our study aimed to (1) evaluate the frequency and causes of delayed denosumab doses at our institution and (2) compare the incidence of delayed doses before and after implementation of a new electronic ordering process.

METHODS:

We performed a retrospective chart audit for all patients receiving two or more denosumab doses at our institution between 1/1/16-8/11/18 and categorized those whose doses were >/=214 days (7 months) as delayed. We reviewed notes, imaging, and labs in a subset of this population to assess reasons for the delay. On 8/11/18, a new outpatient infusion center (OIC) therapy plan went into place. This plan bundled a one-year denosumab order (2 doses) with an automatic referral to the OIC along with physician reminders for renewal. We compared rates of delayed denosumab dosing before and after implementation of this new order process.

RESULTS:

Between 1/1/16-8/11/18, 385 patients received 1295 doses of denosumab, with 160 (41.6%) receiving 193 instances of delayed doses. We reviewed the charts of 98 individuals who received 111 instances of late doses between 7/6/16-8/11/18. The most prevalent reasons for delays were: delays in follow-up by the patient (27.9%), delays in the provider placing an order for the drug and OIC referral simultaneously (27.9%), and delays in OIC scheduling (18%). During the 14 months after implementation of the new ordering process, 347 patients received 614 instances of denosumab, of which 123 (35.4%) received 128 instances of delayed dosing. This is a relative decrease of 17.5% (p=0.09) for the proportion of patients with a late dose.

CONCLUSIONS AND FUTURE DIRECTIONS:

Nearly half of the patients on denosumab in our hospital received delayed denosumab dosing. Delays were often due to a lack of coordination between subsequent dose order placement and referral to the OIC. Our institution successfully implemented a bundled therapy plan to improve timely dosing. By March 2020, we expect to reassess the post-intervention group to further describe reasons for dosing delays. We also will compare rates of VFs associated with delayed denosumab dosing pre- and post-intervention periods.

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<![CDATA[Independent effects of 15 commonly prescribed drugs on all-cause mortality among US elderly patients with type 2 diabetes mellitus]]> https://www.researchpad.co/product?articleinfo=Nfa705d74-826b-4fba-999b-ad24afe57e08

Objective

Most patients with type 2 diabetes mellitus (T2DM) also have hypertension and hyperlipidemia. Consequently, they are taking medications for all three conditions concurrently and the effect of one drug could be confounded with that of another. This study aimed to determine the independent effects of 15 commonly prescribed medications for three conditions on the risk of all-cause mortality among elderly patients with T2DM.

Research design and methods

A cohort of 360 437 elderly patients with T2DM from 2007 to 2016 US Medicare data was traced along with cumulative uses of 8 diabetes, 6 hypertension and 1 hyperlipidemia drugs. The relative risk of all-cause mortality for each study drug was estimated using an extended Cox regression analysis adjusting for the concurrent use of other study drugs.

Results

Compared with the no use of each study medication, mortality risk declined with use of 3 diabetes drugs, sodium-glucose cotransporter-2 inhibitors (HR=0.73; 95% CI 0.64 to 0.84), glucagon-like peptide-1 receptor agonists (HR=0.75; 95% CI 0.70 to 0.80) and dipeptidyl peptidase-4 inhibitors (HR=0.94; 95% CI 0.91 to 0.98), the use of 3 blood pressure medications, diuretics (HR=0.89; 95% CI 0.87 to 0.92), angiotensin receptor blockers (HR=0.86; 95% CI 0.84 to 0.89), ACE inhibitors (HR=0.98; 95% CI 0.95 to 1.01) as well as statins (HR=0.83; 95% CI 0.80 to 0.85). It increased moderately with insulin (HR=1.55; 95% CI 1.51 to 1.59), sulfonylureas (HR=1.16; 95% CI 1.13 to 1.20), a small inconsistent amount with metformin (HR=1.05), beta-blockers (HR=1.07), dihydropyridine calcium-channel blockers (HR=0.99) and non-dihydropyridine calcium-channel blockers (HR=1.05). The use of thiazolidinedione had no effect.

Conclusion

Among older patients with diabetes, mortality risk decreased importantly with three new diabetes drugs, 3 blood pressure drugs and statins. It increased moderately with sulfonylurea and insulin. Studies of aggressive use of new T2DM drugs instead of sulfonylureas and insulin are needed. Our statin results empirically validate two national guidelines for using statins in older patients with diabetes. However, 23% of study patients never took a statin, suggesting missed opportunities for prevention.

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<![CDATA[Assessing the growth in clinical skills using a progress clinical skills examination]]> https://www.researchpad.co/product?articleinfo=N22edf03e-1df8-490d-b170-d8364e3b4da2

Background

This study evaluates the generalizability of an eight-station progress clinical skills examination and assesses the growth in performance for six clinical skills domains among first- and second-year medical students over four time points during the academic year.

Methods

We conducted a generalizability study for longitudinal and cross-sectional comparisons and assessed growth in six clinical skill domains via repeated measures ANOVA over the first and second year of medical school.

Results

The generalizability of the examination domain scores was low but consistent with previous studies of data gathering and communication skills. Variations in case difficulty across administrations of the examination made it difficult to assess longitudinal growth. It was possible to compare students at different training levels and the interaction of training level and growth. Second-year students outperformed first-year students, but first-year students’ clinical skills performance grew faster than second-year students narrowing the gap in clinical skills over the students’ first year of medical school.

Conclusions

Case specificity limits the ability to assess longitudinal growth in clinical skills through progress testing. Providing students with early clinical skills training and authentic clinical experiences appears to result in the rapid growth of clinical skills during the first year of medical school.

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<![CDATA[A Rare ST-Elevation Myocardial Infarction Mimic or a True Event?]]> https://www.researchpad.co/product?articleinfo=N46c3e4c8-4729-4ea7-aee9-281547783666

The etiology of ST-elevation myocardial infarction (STEMI) is either rupture or erosion of unstable plaque with subsequent thrombosis. With the widespread use of plaque-stabilizing lipid-lowering therapies (statins), plaque erosion, rather than rupture, now accounts for most cases of acute coronary syndromes (ACS). In the spectrum of ACS, STEMI usually results from the total occlusion of the culprit epicardial coronary artery, leading to the occlusion of blood flow to the affected myocardium. The differential diagnosis of ST-elevations on electrocardiograms are broad. However, an elevated cardiac marker, evidence of wall motion abnormality on echocardiogram or positive stress testing makes an alternate diagnosis less likely. This prompts emergent coronary angiography with an intent to fix the underlying cause. In some cases like ours, when the clinical suspicion of STEMI is high, the coronary angiography may be unrevealing of the diagnosis.

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<![CDATA[Competency-based medical curriculum: Psychiatry, training of faculty, and Indian Psychiatric Society]]> https://www.researchpad.co/product?articleinfo=N9305a720-7500-442f-b8b3-59db828ddead ]]> <![CDATA[A Post-operative Masquerade: Simulation-based Scenario Challenging Clinical Clerks to Recognize an Atypical Presentation of Myocardial Infarction]]> https://www.researchpad.co/product?articleinfo=Nc3ce8615-483b-47ec-8ec0-99acf94eb142

Post-operative myocardial infarctions (MI) are a challenging diagnosis due to the alterations in the presenting complaint compared to an acute MI. Patients may be asymptomatic due to their anesthetics and sedatives from their operation which may create clinical confusion. As such, there is an increased risk for delayed administration of reperfusion therapies in this patient population which has shown to increase morbidity and mortality. It is anticipated that the difficulty of recognizing a post-operative MI would be exacerbated for clinical clerks due to their lack of clinical experience and overstimulation. Fortunately, the use of simulation-based learning has been proven to be a useful teaching tool to help clinical clerks manage medical problems in a controlled environment. This technical report describes a simulation case designed to enhance the recognition and response to a post-operative MI by a third-year clinical clerk. In this scenario, a 56-year-old male accountant presents with shortness of breath while recovering in the orthopaedic ward 12 hours following a total knee replacement (TKR). The clinical clerks are expected to conduct an independent follow-up prior to finishing their shift during which the patient begins complaining of shortness of breath. The clerk is required to order an electrocardiogram (ECG) for further analysis which reveals an anterior ST-segment elevation. Once recognized, a request for the crash cart and patient handover to the senior physician are expected.

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<![CDATA[Eye care providers’ emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review]]> https://www.researchpad.co/product?articleinfo=N5a4f6065-3bce-4af3-80f2-19c49f62004d

US adults visit eye care providers more often than primary healthcare providers, placing these doctors in a prime position to help identify and manage patients with prediabetes and diabetes. Currently, diabetes is identified in eye clinics in an advanced stage, only after visible signs of diabetic retinopathy. Recent ophthalmic research has identified multiple subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease. The corneal epithelium exhibits increased defects and poor healing, including an increased risk of neurotrophic keratitis. Increased thickness and stiffness of the cornea artificially alters intraocular pressure. There is damage to the endothelial cells and changes to the bacterial species on the ocular surface, both of which can increase risk of complications with surgery. Decreased corneal sensitivity due to a loss of nerve density predispose patients with metabolic disease to further neurotrophic complications. Patients with diabetes have increased Meibomian gland dysfunction, blepharitis and reduced tear production, resulting in increased rates of dry eye disease and discomfort. Early detection of metabolic disease may allow eye care providers to be more proactive in recommending referral and intervention in order to reduce the risk of blindness and other diabetes-related morbidity. Continued research is needed to better understand the time course of changes to the anterior segment and what can be done to better detect and diagnose patients with prediabetes or undiagnosed diabetes and provide improved care for these patients.

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<![CDATA[Correlation of Medical College Admission Test Scores and Self-assessment Materials with the United States Medical Licensing Examination Step 1 Performance]]> https://www.researchpad.co/product?articleinfo=Ndfa78704-8a5e-4c47-9d9a-0489deac1e03

Purpose

Candidates' performance on the United States Medical Licensing Examination (USMLE) Step 1 examination had been correlated with the Medical College Admission Test (MCAT). However, in 2015, a new MCAT format was released and its correlation with Step 1 remains to be fully analyzed. Preparation for Step 1 typically involves purchasing and perusing practice tests from the National Board of Medical Examiners (NBME) and UWorld; however, their predictive value to performance on Step 1 remains to be ascertained, especially with the release of five new NBME practice tests. Additionally, there is a need for accurately predicting Step 1 scores to self-evaluate study progress and reduce student anxiety.

Rationale

Program directors rank USMLE Step 1 scores as the number one criterion in selecting interviewees for residency. Step 1 scores are more important than Step 2 scores, Dean’s letter, or other letters of recommendation in determining the overall ranking of a candidate after interviews.

Hypotheses

The authors hypothesized that the new MCAT scores correlated positively with Step 1 scores and that the new NBME practice tests were more predictive of performance on Step 1 as compared to old NBME tests. 

Methods

Linear regression analysis followed by either analysis of variance (ANOVA) or Student's t-tests were used to analyze 399 responses. Data obtained was used to update an existing Step 1 score predictor, which was then validated.

Results

A positive correlation between the MCAT (average score: 510.1 ± 6.3) and Step 1 scores (average score: 246.1 ± 14.2) was observed. While new NBME practice tests were more predictive of Step 1 scores than old NBME tests, UWorld test scores were the most predictive. Students who practiced with the new NBME practice tests scored significantly higher than students who did not use them. However, students using any of the UWorld practice tests did significantly better than students who practiced using only NBME practice tests but not UWorld practice tests. Ironically, NBME16,the second-most correlativetest to Step 1 performance, is no longer available for purchase. Overall, taking six or more practice tests significantly enhanced Step 1 scores; the optimal number of tests was found to be between six and nine. The predicted score by an updated Step 1 score predictor was within 3.8 points or 1.6% of the actual Step 1 score.

Conclusions

We believe this study will aid in the selection and purchase of appropriate self-assessment tests as preparatory material for the USMLE Step 1 examination. It will also introduce them to an existing Step 1 score predictor that will help determine their readiness for Step 1.

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<![CDATA[Orthopaedic Trainee Opinion on the Current Procedure-based Assessment Compared to its Predecessor: A UK Trauma Centre Perspective]]> https://www.researchpad.co/product?articleinfo=N6b87b54f-1326-4404-9628-9c3b5d816b7a

Background

Procedure-based assessments (PBAs) were introduced as a formative assessment of surgical performance. UK trainees are currently expected to complete at least 20 PBAs each training year. A new PBA tool was introduced in August 2016 in order to address several criticisms with its predecessor. These included mandatory written feedback and increasing the number of global levels of assessment.

Objectives

Our study sought to identify the impact of these modifications to the PBA tool on its perceived utility as a formative assessment of surgical skill.

Study design & methods

Orthopaedic trainee registrars (ST3-ST8) holding a UK National Training Number (NTN) at a major UK trauma centre were invited to take part in the study. Each trainee completed an anonymous questionnaire that was designed to elicit the view of trainees towards the old and new PBA.

Results

Twelve trainees took part in the study. Most of them admitted receiving good quality feedback from their trainer using both tools (75% old PBA; 83% ew PBA). Most trainees (58%) felt that written feedback did not encourage verbal feedback from their trainer. Overall, trainees felt the new PBA global rating scale levels had made it a more accurate measure of surgical performance and allowed them to better appreciate the gradual improvement in their surgical skills throughout their training.

Conclusions

Fifty per cent of the trainees believed that the new PBA overall was a better formative assessment of surgical skill than its predecessor. A significant factor has been the introduction of a new global rating score rather than efforts to improve feedback. Further work should look to identify whether these views match those of other UK-based trainees on a larger scale.

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<![CDATA[Constructing a Multidisciplinary Network That Relies on Disruptive Technologies to Design, Test, and Implement Simulation Training]]> https://www.researchpad.co/product?articleinfo=N45a2bbaf-94a5-45b5-adef-7e00fbb80c44

MaxSIMhealth is a multidisciplinary network of manufacturing, design, and simulation labs at Ontario Tech University combining expertise in health sciences, business and information technology (IT), and engineering while building community partnerships to advance simulation training. It discovers existing simulation gaps, provides innovative solutions that change systems, and leads to improved healthcare outcomes. Specifically, it utilizes disruptive technologies, including 3D printing, gaming, and extended reality, as innovative solutions that deliver cost-effective, portable, and realistic simulation, which is currently lacking. MaxSIMhealth is a novel collaborative innovation with aims to develop future cohorts of scholars with strong competencies ranging from technology application, to collaborating in new environments, communicating professionally, and problem-solving. Its work will transform current health professional education landscapes by providing novel, flexible, and inexpensive simulation environments. This editorial aims to showcase maxSIMhealth's innovative strategy focusing on collaborations of expertise in order to develop new simulation solutions that advance the health industry.

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<![CDATA[Structural Elements of the Biomechanical System of Soft Tissue]]> https://www.researchpad.co/product?articleinfo=Nf54e0e70-61a6-4741-8159-78d5518f370e

In living organisms, forces are constantly generated and transmitted throughout tissue. Such forces are generated through interaction with the environment and as a result of the body’s endogenous movement. If these internally or externally originating forces exceed the ability of tissues to cope with the applied forces, (i.e. “tissue thresholds”), they will cause force-related tissue harm. However, biotensegrity systems act to prevent these forces from causing structural damage to cells and tissues. The mechanism and structure of soft tissues that enable them to maintain their integrity and prevent damage under constantly changing forces is still not fully understood. The current anatomical and physical knowledge is insufficient to assess and predict how, why, where, and when to expect force-related tissue harm.

When including the concept of tensegrity and the related principles of the hierarchical organisation of the elements of the subcellular tensional homeostatic structure into current biomechanical concepts, it increases our understanding of the events in force handling in relation to the onset of force-related tissue harm: Reducing incident forces in tissue to a level that is not harmful to the involved structures is achieved by dissipation, transduction and transferring the force in multiple dimensions. To enable this, the biomechanical systems must function in a continuous and consistent way from the cellular level to the entire body to prevent local peak forces from causing harm. In this article, we explore the biomechanical system with a focus on biotensegrity concepts across several organisational levels, describing in detail how it may function and reflecting on how this might be applied to patient management.

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<![CDATA[The Impact of COVID-19 on Medical Education]]> https://www.researchpad.co/product?articleinfo=N2afc9b83-303f-4395-9b7f-a33091601760

In the wake of the novel coronavirus (COVID-19) pandemic, it is abundantly clear to all the necessity of studying the pathology and widespread health consequences associated with the virus. However, what is much less clear is the impact of COVID-19 on medical education. Already, faculty and medical students are grappling with the changes that have been made and attempting to consolidate these with their plan of career development. Changes that may seem relatively minor in comparison to the global pandemic have the potential to be drastic turning points in the career progression of many. As not much is known regarding the long-lasting impact of COVID-19 on medical education, it is therefore also necessary to record and study the full impact of the changes being made.

The path to entering a successful residency has been predictable for the last few years - do well on Step 1, give conference presentations, go the extra mile in clerkships and shadowing opportunities, and have meaningful non-academic extracurricular activities - all of which designed to best demonstrate a student's knowledge, persistence, collaborative spirit, and dedication to medicine. This trajectory has been changed with COVID-19 disrupting routines in hospitals, medical schools and beyond. The replacement of in-person classes with online equivalents is an obvious necessity at this time but creates a loss of collaborative experiences that has the potential to be a significant detriment to education. Likewise, the cancellation of clerkships, which are necessary for both skill acquisition as well as for relationship building, is a serious issue which students and medical schools must now resolve. Many medical students have also lost the opportunity for personal development through conference presentations. These presentations play a large role in distinguishing applicants during the residency application process, and therefore these lost opportunities have the potential to be a serious detriment to medical students’ career trajectory. While implementing technology to help resolve these issues is a unique way to help students to develop these skills, it is now necessary for medical students to demonstrate the same set of skills which they would have previously in a completely new and innovative manner.

Persistence and adaptability during this time of challenge are attributes that medical students can demonstrate more readily. While every student has a personal story of how COVID-19 has impacted their education, there is no question that the impacts of COVID-19 will be felt on an extensive level. The panic in the community is palpable, and many are confused by how to proceed in the wake of COVID-19. This is no different for medical students and faculty and the questions that arise regarding medical education and their future careers.

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<![CDATA[Students tell us what good written feedback looks like]]> https://www.researchpad.co/product?articleinfo=N7b33820e-afa5-43ef-b700-b02f69979e5b

Feedback can be an important element of learning, but only if students engage with it. Students are only likely to engage with feedback that they find useful. This study aimed to identify characteristics of written feedback perceived by students as effective. We used a mixed‐method approach, integrating quantitative and qualitative data that were collected through the analysis of feedback that was identified by students as good, a student questionnaire, as well as interviews and a focus group exploring students’ views on what good feedback looks like. Although the results show that length and composition of ‘good’ feedback can be extremely variable, some common characteristics could be identified, leading to a set of recommendations for staff marking written assessments. According to students, good feedback should be detailed and specific, and it should tell students how they can improve. Students also find it important that feedback is honest and constructive. In addition, positive reinforcement was identified as important by the focus group, although few examples of good written feedback on the assignment contained any direct praise. Surprisingly, feedforward which might help students in other modules did not feature highly in students’ perceptions of good feedback, possibly indicating a focus by students on improving the current assignment rather than on future assignments.

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<![CDATA[Database of the alumni performance of the Ophthalmology Stricto sensu Postgraduate Program at Escola Paulista de Medicina, UNIFESP 1 ]]> https://www.researchpad.co/product?articleinfo=Nd4f881b8-cb2f-4568-b6d6-98d5fbe8b49b

Abstract

Purpose

To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers.

Methods

The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates’ e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs.

Results

The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers.

Conclusion

For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.

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<![CDATA[Perceived Anxiety is Negligible in Medical Students Receiving Video Feedback During Simulated Core Practical Skills Teaching: A Randomised Trial Comparing Two Feedback Modalities]]> https://www.researchpad.co/product?articleinfo=N3450d408-55a2-44d7-9183-2c082551b615

Introduction

The ability to undertake simple practical procedures is essential for graduating medical students and is typically assessed using simulated models. Feedback is a key component of the learning process in developing proficiency in these key skills. Video feedback (VF) has previously shown promise, however, negative effects of VF-related anxiety on performance have been previously reported. Our aim was to investigate for a difference in participant anxiety between supervised individualised video feedback (SIVF) and unsupervised generic video feedback (UGVF) when undertaking simulated basic practical procedures.

Methods

Undergraduate medical students participating in a clinical skills study to compare UGVF and SIVF completed a Likert scale questionnaire detailing perceived anxiety. During the study, students were recorded performing three basic surgical skills (simple interrupted suturing, intravenous cannulation, urinary catheterisation). Feedback was then provided by one of two methods: (1) SIVF - participant video footage reviewed together with a tutor providing targeted feedback, and (2) UGVF - participant video footage reviewed alone with concurrent access to a generic pre-recorded ‘expert tips' video clip for comparison. Each participant received SIVF and UGVF at least once.

Results

The majority of participants did not find either SIVF (81.7%) or UGVF (78.8%) stressful. Students had a strong preference for SIVF (77.5%) and disagreed that similar ‘face-to-face’ feedback had impaired learning in the past (80.3%).

Conclusion

Medical student-perceived anxiety is negligible when video feedback is employed during simulated core practical skill training.

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<![CDATA[Developing ClerkCast: An Emergency Medicine Clerkship Needs Assessment Project]]> https://www.researchpad.co/product?articleinfo=Nd955ebfa-a8d6-44fa-b914-adfa9cd6bcfd

Introduction and Objectives: For Canadian medical students completing their emergency medicine (EM) clerkship rotation, developing an approach to undifferentiated patients can be difficult. Open educational resources (OERs) are a convenient solution, but faculty authored materials may not meet students’ needs. There is a lack of EM OERs that deconstruct these undifferentiated EM presentations for medical students. The objective of this study was to identify EM topics poorly understood by medical students to inform a novel Free Open Access Medical Education podcast curriculum for approaching undifferentiated EM patients for medical students.

Methods: An online survey-based needs assessment was distributed to key stakeholders through direct email, social media, and the blog CanadiEM. The survey included 32 EM topics graded on a five-point Likert scale according to how much participants believe medical students require further teaching.

Results: Over six weeks, a total of 74 participants completed the needs assessment survey, and 58 participants met the criteria for inclusion into our study: medical students (n=23) and EM educators (inclusive of resident physicians (n=19), and staff EM physicians (n=16)). A number of presentations (n=23) were prioritized by both students and EM educators to be of the greatest need for medical students. No presentations identified as high priority by students were not also identified as high priority by EM educators.

Conclusions: The greatest mean topic scores in both EM educators and medical student responses included critical care and acute medicine topics. Of the 32 topics in the survey, 23 topics were determined to be high priority for the development of future online educational resources. Analysis of free-text responses revealed nine topics not previously listed in our survey. Our findings will be used to inform the development of our new open access podcast and can be useful for developing medical student curricula in EM.

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<![CDATA[Vaping: An Emerging Health Hazard]]> https://www.researchpad.co/product?articleinfo=Na6038f2e-0226-40aa-9c3e-48c2dd5ba645

Electronic cigarettes (e-cigarettes) are electronic devices designed to vaporize chemical compounds. The device is made up of a mouthpiece, liquid tank, a heating element, and a battery. E-cigarette use may pose health risks in the form of cardiovascular and respiratory diseases. These health risks have implications to not only the primary user, but the aerosols can also cause secondhand and thirdhand injuries to others in the vicinity. Acute lung injury may also be associated with the use of e-cigarettes, but the underlying cause remains unknown. Clinicians, including hospitalists, pulmonologists, intensivists, medical examiners, pathologists, and the like, should report possible cases as the medical community continues to assess the health risks of e-cigarette use.

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<![CDATA[Mycoplasma Pneumoniae Induced Rash and Mucositis with Bilateral Otitis Media and Sinusitis]]> https://www.researchpad.co/product?articleinfo=N53d81fb9-89c7-40e8-9734-6523a8bf3493

Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a recently identified clinical entity, which describes a subset of extrapulmonary manifestations resulting from Mycoplasma pneumonia infection. Patients present with a wide variety of symptoms including cough, dyspnea, mucositis, conjunctivitis, with or without a variable cutaneous rash. A 24-year-old male presented to the emergency department with worsening dyspnea and new-onset oral, ocular, and genital mucosal lesions. The patient was also found to have bilateral otitis media with tympanic membrane rupture and ethmoid sinusitis upon further evaluation. The patient was originally diagnosed with atypical pneumonia leading to acute hypoxic respiratory failure and was admitted to inpatient care. Work-up revealed positive Mycoplasma pneumoniae immunoglobulin M, and the patient was subsequently diagnosed with MIRM. The patient was provided with supportive care as well as systemic antibiotics, and he fully recovered by day 12 without complication. No standardized treatment guidelines exist for MIRM, and it is universally accepted that supportive management is the mainstay of treatment, consisting of pain management, intravenous hydration, and mucosal care. Although the majority of MIRM patients are generally known to have a full recovery (81%), a variety of ocular, oral, and genital complications have been noted in the literature. Here we present a unique case of MIRM in a 24-year-old male who also had ethmoid sinusitis and bilateral otitis media with unilateral tympanic membrane perforation - two head and neck symptoms not described in previous literature.

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<![CDATA[Establishment of consensus on content and learning objectives for an interprofessional education in childhood cancer: a Delphi survey]]> https://www.researchpad.co/product?articleinfo=N806aeb3c-9e72-4dfd-9e30-85404c041304

Background

Complex treatment, care and rehabilitation require continuous healthcare professional development and maintenance of competencies in collaboration with other professionals. Interprofessional education in childhood cancer involves several groups of healthcare professionals with both general and specific knowledge and skills.

Objective

To establish consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer.

Design

A three-round Delphi survey in Scandinavian childhood cancer departments.

Participants

Healthcare professionals appointed by their head of departments and head nurses based on their profession and their involvement in continuing professional development.

Main outcome measures

A prioritised list of interprofessional learning objectives with a mean score of ≥3 on a five-point scale (1=not relevant, 5=extremely relevant).

Results

12 childhood cancer departments participated with 30 healthcare professionals: 11 nurses, 10 medical doctors, 5 social workers, 2 physiotherapists and 2 pedagogues. In total, 28 (93%), 25 (83%) and 22 (73%) completed the first, second and third round, respectively. In the first round, we asked open-ended questions and used directed content analysis to analyse 386 statements. We formulated 170 interprofessional learning objectives in six categories: (1) acute life-threatening situations, (2) gastrointestinal toxicities and side effects, (3) pain, (4) palliation, (5) play and activity, and (6) prescription and administration of medicine. The second round resulted in 168 interprofessional learning objectives receiving a mean score of ≥3 on a five-point scale. Final agreement in the third round resulted in a prioritised list of 168 learning objectives.

Conclusions

Consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer was established across five groups of healthcare professionals in three countries. Some learning objectives are generic and can be applied in settings other than childhood cancer, where healthcare professionals collaborate to provide patients and families optimal treatment and care.

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