Demand for bedside ultrasound in medicine has created a need for earlier exposure to ultrasound education during the clinical years of undergraduate medical education. Although bedside ultrasound is often used for invasive medical procedures, there is no standardized educational model for procedural skills that can provide the learner a real-life simulated experience. The objective of our study was to describe a unique fresh cadaver preparation model, and to determine the impact of a procedure-focused ultrasound training session. This study was a cross-sectional study at an urban academic medical center. A sixteen-item questionnaire was administered at the beginning and end of the session. Fifty-five third year medical students participated in this 1-day event during their surgical clerkship. Students were trained to perform the following ultrasound-guided procedures: internal jugular vein cannulation, femoral vein cannulation femoral artery cannulation and pericardiocentesis. Preparation of the fresh cadaver is easily replicated and requires minor manipulation of cadaver vessels and pericardial space. Fifty-five medical students in their third year participated in this study. All of the medical students agreed that US could help increase their confidence in performing procedures in the future. Eighty percent (95 % CI 70-91 %) of students felt that there was a benefit of learning ultrasound-based anatomy in addition to traditional methods. Student confidence was self-rated on a five-point Likert scale. Student confidence increased with statistical significance in all of the skills taught. The most dramatic increase was noted in central venous line placement, which improved from 1.95 (SD = 0.11) to 4.2 (SD = 0.09) (p < 0.001). The use of fresh cadavers for procedure-focused US education is a realistic method that improves the confidence of third year medical students in performing complex but critical procedures.
What problem was addressed? There has been a decline in the time devoted to instruction on anatomy in medical schools, especially with the introduction of system-based learning. This lack of teaching has been cited as having negative implications with regard to patient safety. 1 In response to the challenge of integrating anatomy into a system-based curriculum, we introduced a flipped classroom (FCR) format with videos for the musculoskeletal block (MSB) of the curriculum, with the goals of: (i) making anatomy clinically relevant, (ii) using classroom time for group problem solving and investigation of clinical vignettes, and (iii) promoting understanding rather than rote memory of anatomy. Below, we discuss our mistakes, successes and insights when implementing the FCR in the MSB. What was tried? We constructed videos with an average length of 35-40 minutes for each anatomical region (upper extremity and lower extremity), describing each muscle, its function and its clinical correlation. Students viewed the videos prior to the class and completed a quiz at the beginning of each classroom session to assess their knowledge of the basic information contained in the video. We measured student satisfaction in a post-FCR session questionnaire at the end of the MSB, in which students compared the standard lecture format with the FCR and provided suggestions for improvement. What lessons were learned? Student responses to our questionnaire noted that the video sessions were too long, showing a preference for 20-minute videos instead. Initially, we presented all the muscles, which took time away from teaching. To ameliorate this issue, we now focus on muscle groups rather than individual muscles, allowing for a better understanding of functional anatomy. Moreover, originally we attempted to use clinical correlations in the video to illustrate key points. We used similar correlations during the classroom sessions and many students viewed the video and classroom sessions as redundant; presently, we include clinical correlations only in classroom discussions. We learned that it was more useful to focus on fewer clinical cases than to cover many superficially and equally important to separate distinct anatomical areas into different FCR sessions. For example, at first we incorporated the topic of the brachial plexus in the upper extremity video, but now we have a separate session for the brachial plexus itself.In the early stages of the FCR we asked students open-ended questions, but we often received responses from the same few students. To address this problem, we transitioned to using board-like questions to simulate USMLE Step 1 and promote discussion of correct and incorrect answers. To encourage more participation, we will use an electronic polling system. This system will give us feedback with regard to areas of weakness that require more attention.Additionally, students received 2 points (out of a possible 200 in the course) if they achieved ≥75% in the in-class quiz. Students asserted that this gave them enough inc...
IntroductionCareer advising for medical students can be challenging for both the student and the adviser. Our objective was to design, implement, and evaluate a “flipped classroom” style advising session.MethodsWe performed a single-center cross-sectional study at an academic medical center, where a novel flipped classroom style student advising model was implemented and evaluated. In this model, students were provided a document to review and fill out prior to their one-on-one advising session.ResultsNinety-four percent (95% CI, 88%–100%) of the medical students surveyed felt that the advising session was more effective as a result of the outline provided and completed before the session and that the pre-advising document helped them gain a better understanding of the content to be discussed at the session.ConclusionUtilization of the flipped classroom style advising document was an engaging advising technique that was well received by students at our institution.
Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.
BackgroundAfter emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.ObjectivesTo determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.MethodsOur ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.ResultsSixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters – 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters – 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians and three (23%) encounters were with UC resident physicians.ConclusionPreliminary data suggest that incorporating Spanish language and cultural competency into residency training has an overall beneficial effect on patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.
Ethnic disparities in pain assessment and analgesic administration following surgery have received little attention in the surgery literature. We noted that our Native American patients were less likely than others to complain of pain. A retrospective chart review of 21 Native American patients and a control group who underwent outpatient, elective laparoscopic cholecystectomy was performed. Native American patients had a statistically lower numeric pain score (mean, 6.5; 95% CI, 3.6-9.4) than non-Native American patients (mean, 8.1; 95% CI, 6.3-9.9; t38 = 2.63; P < .05). Native American patients also received less postsurgical analgesic (mean, 7.4; 95% CI, 4.0-10.8) than non-Native American patients (mean, 11.2; 95% CI, 7.2-15.2; t38 = 3.07; P < .01). Medical staff attending Native American patients should be aware that response to some scales to assess pain may not reflect accurately the degree of pain experienced.
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