SUMMARY
Background
Near- peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting.
Method
Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre- simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post- simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers.
Results
Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post- simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors.
Conclusion
Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.
Key Points
Question
What is the association of Medicaid expansion under the Patient Protection and Affordable Care Act with suicide rates?
Findings
Although suicide rates increased from 2000 to 2018 across all states in this cross-sectional study, a statistically significant attenuation of −0.40 suicides per 100 000 people was found in Medicaid expansion states compared with nonexpansion states, translating to 1818 fewer suicides from 2015 to 2018.
Meaning
These findings suggest that Medicaid expansion, which increases mental health coverage, is associated with a decrease in suicide mortality.
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