INTRODUCTION: Appropriate documentation is an important component of quality health care. In academic medical centers, most documentation is done by residents. Given the scope of topics for resident education, a formal curriculum for documentation is often non-existent. Poor documentation has important consequences, including financial loss and compromise of quality indices. We sought to determine if instructing residents in basic coding principles improved the rate of appropriate documentation for early-term deliveries. METHODS: Residents were given a one-hour lecture focused on inpatient documentation, with a section on documenting appropriate justification for early-term deliveries. Subsequent documentation over a one-week period by each of the second- and third-year residents in attendance (n=7) was reviewed, and the rate of appropriate documentation for early-term deliveries was compared to similar documentation prior to the intervention for the same residents. This was compared to documentation by second- and third-year residents who did not attend the lecture (n=9). RESULTS: There were 153 total encounters analyzed. 29 were for patients who underwent early-term delivery. Of the pre-intervention early-term deliveries, the reasons for delivery in 8/13 (61.5%) were incorrectly documented. Of the post-intervention early-term deliveries, the reasons for delivery in 6/16 (37.5%) were incorrectly documented. 5/6 (83.3%) of the post-intervention early-term deliveries which were incorrectly documented were by residents who had not attended the lecture. CONCLUSION: Teaching residents coding and formal documentation is a valuable intervention. These simple interventions stand to make a significant impact on both financial and quality indices. These interventions will also serve to better prepare trainees for their transition into practice.
INTRODUCTION: Coaching and debriefing after simulated exercises are both well-established approaches to enhancing education and personal performance. Coaching may also have an important role in training interdisciplinary teams for obstetric emergencies. We sought to understand factors which create an optimal environment for coaching interdisciplinary obstetric rapid-response teams. METHODS: An interdisciplinary simulation drill was conducted for our institution's obstetric rapid-response team. The individuals leading the debriefing session were varied by discipline, and participants' responses in a post-simulation survey were analyzed to determine if receiving feedback from a person from one's own discipline is important to satisfaction with the assessment process. Participants were asked to rank their satisfaction with feedback on a numerical scale (1-10, 10=best). We also posed questions regarding acceptance of video recording and playback in a group setting. RESULTS: There was no difference among obstetricians (n=3), anesthesiologists (n=3), or nurses (n=8) regarding feedback received from a representative of their own discipline versus a representative from a different discipline. The majority believed that recording the simulation and playing it back during the team debrief would be helpful. None of the participants indicated that recording the simulation and playing it back during the debrief would deter them from participating. CONCLUSION: Our pilot exercise indicates that participants respond equally to feedback given by a representative of their own discipline as to feedback given by a representative of a different discipline. Interdisciplinary coaching for rapid-response team simulations was well-accepted. The addition of a video recording appears to be a welcome addition to the debrief process.
INTRODUCTION: The objective of our study is to evaluate the ultrasound knowledge before and after a hands-on workshop, designed to increase basic ultrasound knowledge among physicians and midwives from rural health centers in the Cusco region of Peru. METHODS: A basic three-day ultrasound curriculum tailored to specific needs was created by fellows. It included lectures, hands-on training. Thirty-three physicians and midwives attended the conference. A pretest was completed prior to starting the course. A posttest was given at the end of the course. The tests evaluated basic ultrasound knowledge, fetal biometry and anatomy, placenta and amniotic fluid, and hydatid cysts. The primary outcome was total test scores. Secondary outcomes included the scores in specific areas. Statistical analysis was performed using univariate analyses and a P<0.05 was considered statistically significant. RESULTS: Twenty-nine pretests and thirty-two posttests were completed. The mean percentage of correct answers in the pretest was 29.8% (IQR 21.1-31.6) and in the posttest was 77.1% (IQR 73.7-84.2), (p<0.0001) Participants showed significant improvement in scores in 13 out of the 19 questions included. The areas with most improvement were basic ultrasound knowledge and fetal biometry and anatomy. The percentages of correct answers on each area were: basic ultrasound knowledge: 25.6% vs. 78.6% (p<0.0001), fetal biometry and anatomy: 24.1% vs. 86.5% (p<0.0001), placenta and amniotic fluid: 35.3% vs. 60.2% (p<0.0001), and hydatic cyst: 50% vs. 78.1% (p<0.0001). CONCLUSION: A multidisciplinary 3-day ultrasound course tailored to identified needs of a Low-Middle-Income Country setting had a significant impact on the knowledge acquired by the participants.
INTRODUCTION: Abroad medical volunteer work by United States citizens accounts for over one billion dollars in unpaid labor annually. The effectiveness of medical volunteerism in developing countries has been questioned. Changing the paradigm from assistance to capacity building might have a bigger and more permanent impact. The aim of our study is to evaluate a training intervention performed with Peruvian Ministry of Health personnel and determine its immediate impact. METHODS: This 2 day hands-on workshop was given by MFM and Infectious disease fellows, and focused on obstetric and neonatal emergencies. Midwifes and general physicians were invited to participate. Pre and post-workshop tests were conducted. The tests evaluated knowledge in management of pre-eclampsia, post-partum hemorrhage, ectopic pregnancy, maternal sepsis, and neonatal respiratory support. Total and topic specific mean scores in the pre and post-tests were compared using Chi square. RESULTS: A total of 47 healthcare professionals participated in the workshop and 38 answered both tests. Six were physicians, 6 registered nurses, and 35 midwifes. There was a significant improvement in the total score (12.9 vs 15.9, p<0.01) as well than in the areas of preeclampsia (1.5 vs 2.7 p<0.01), maternal sepsis (1.6 vs 2.4 p<0.01) and neonatal respiratory support (3.9 vs 4.4 p 0.05). CONCLUSION: Comparison of the pre and post-tests scores showed improvement in knowledge in general and in preeclampsia, maternal sepsis and neonatal respiratory support. The immediate effects of this intervention were positive. Further studies should be performed to evaluate the long term effects of these multidisciplinary workshops.
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