Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and ...Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored. However, students' ability to perceive uncertainty and their approach to uncertain stimuli play a crucial role in enabling them to develop adaptive responses to uncertainty, necessary for their comfort in these situations. Defining uncertainty as a metacognitive state suggests significant variability in its perception among individuals and within an individual over time. Moreover, several studies have demonstrated the substantial influence of various individual and contextual factors on how individuals perceive and respond to uncertainty. In this paper, the authors present multiple hypotheses to address the question of whether students genuinely perceive uncertainty stimuli when they should. The authors argue that students' personal relationship with their knowledge is essential in their ability to identify clinical uncertainty, particularly concerning the limits of medical knowledge. Therefore, they propose that an academic culture fostering doubt, through exposing students to a variety of perspectives, would enhance their ability to identify uncertainty zones in a clinical situation at an early stage. Drawing on Dewey's situational theory, the authors emphasize the importance of better understanding, in a work setting, the influence of contextual and situational characteristics on individual perceptions of uncertainty. In line with this idea, ethnographic studies would offer valuable insights into identifying the relationship between the students, their work environment, and their perception of clinical uncertainty.
Population-based studies directed at promoting physical activity in youth have shown limited success in obesity prevention.
To assess whether an intervention integrating environmental changes to ...induce sustained changes in physical activity, prevents overweight in adolescents.
Four-year randomized trial started in 2002 in eight middle schools of Eastern France. The intervention, randomized at school level, was designed to promote physical activity by changing attitudes through debates and attractive activities, and by providing social support and environmental changes encouraging physical activity.
Nine hundred and fifty four 12-year-old six-graders.
Body mass index (BMI), body composition, physical activity by questionnaire, plasma lipids and glucose, insulin resistance.
Intervention students had a lower increase in BMI (P=0.01) and age- and gender-adjusted BMI (P<0.02) over time than controls. The differences across groups of the age- and gender-adjusted BMI changes (95% confidence interval (CI)) were -0.29 (-0.51; -0.07) kg/m2 at 3 years, -0.25 (-0.51; 0.01) kg/m2 at 4 years. An interaction with baseline weight status was noted. The intervention had a significant effect throughout the study in initially non-overweight adolescents (-0.36 (-0.60;-0.11) kg/m2 for adjusted BMI at 4 years), corresponding to a lower increase in fat mass index (P<0.001). In initially overweight adolescents, the differences observed across groups at 2 years (-0.40 (-0.94; 0.13) kg/m2 for adjusted BMI) did not persist over time. At 4 years, 4.2% of the initially non-overweight adolescents were overweight in the intervention schools, 9.8% in the controls (odds ratio=0.41 (0.22; 0.75); P<0.01). Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised physical activity (P<0.0001), a decrease of TV/video viewing (P<0.01) and an increase of high-density cholesterol concentrations (P<0.0001).
Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents. Our study provides evidence that prevention of obesity in youth is feasible.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objectif
: Ce travail s’inscrit dans une démarche d’ingénierie des compétences visant à évaluer par la simulation les étudiants et les internes en médecine d’urgence (MU). L’objectif de l’étude est ...de développer un score d’évaluation par la simulation pour trois familles de situation (FS).
Matériels et méthodes
: Le choix des trois FS a été fait après un classement selon leur importance, réalisé par les coordonnateurs régionaux du diplôme d’études spécialisé de MU. La seconde étape consistait en une méthode Delphi, pour élaborer une grille d’évaluation des étudiants sur ces FS. Parmi les 86 experts sollicités, l’objectif était d’avoir 20 experts pour chaque FS, qui devraient noter des items en fonction de leur pertinence à évaluer, sur une échelle de Likert pour le premier et le deuxième tour puis sur un score binaire au tour final. Le consensus a priori était de 75 % pour les deux premiers tours puis de 85 % pour le dernier tour.
Résultats
: Les trois FS identifiées sont l’arrêt cardiorespiratoire, la détresse respiratoire aiguë et le coma non traumatique. Cinquante et un experts ont accepté de participer (59 %). Le taux de participation a varié de 80 à 95 % pour chaque tour, et les experts ont identifié 20 catégories composant un score d’évaluation pour chaque situation.
Conclusion
: Grâce à une méthode de consensus de groupe, nous avons pu déterminer les items indispensables à l’évaluation en simulation de trois situations cliniques graves en MU.
Aim
: Our work is part of a competence-based assessment approach. Our aim was to determine three clinical situations that need a simulation-based-assessment for medical students and residents and then, to develop a score for each situation.
Material and methods
: We have conducted two consensus groups’ methods. First, we have asked all French residency program directors in emergency medicine to determine the clinical situations that we had to score. The second step consisted in the use of a Delphi technique, in three rounds, to achieve consensus and to select items that had to be part of the assessment score. Among the 86 solicited experts, we aimed to have 20 experts for each of the three scores.Within the rounds 1 and 2, experts were asked to note items on a Likert scale, and for the last round on a binary scale. For rounds 1 and 2, consensus rate of 75% was agreed upon. It was 85% for round 3.
Results
: The directors identified those clinical situations: cardiac arrest, acute respiratory failure and non-traumatic coma. Response rates for the Delphi were 59% for the overall participation, and then varied from 80 to 95% in each round, for each score. We have found 20 categories for each situation, and made scores with those categories.
Conclusion
: With the help of consensus groups’ methods, we have found three clinical situations important to assess by simulation in emergency medicine, and developed a score for each situation, made of 20 categories.
Résumé
Objectif
Nous en savons très peu sur la façon dont les médecins urgentistes raisonnent afin de prendre des décisions diagnostiques et thérapeutiques. Les erreurs de raisonnement sont pourtant ...à l’origine de la majorité des erreurs diagnostiques survenant dans le cadre de la pratique clinique. Cet article présente à l’attention des praticiens et des enseignants de médecine d’urgence les principaux résultats d’une vaste étude qui a réuni entre 2010 et 2015 une équipe internationale de chercheurs issus de plusieurs disciplines, avec pour objectif de modéliser l’expertise en médecine d’urgence.
Matériel et méthodes
Nous avons mené une recherche observationnelle prospective multicentrique basée sur une approche qualitative. Des entretiens ont été réalisés avec des médecins urgentistes experts jusqu’à saturation des données. Ils concernaient la prise en charge récente d’une situation d’urgence. Ils étaient sous-tendus par l’enregistrement vidéo de la situation selon le propre point de vue des médecins.
Résultats
Les médecins urgentistes interviewés utilisent essentiellement leur intuition, qui se forge très rapidement, sur la base de deux à quatre informations cliniques et contextuelles. Ils trouvent souvent le bon diagnostic avant même d’avoir rencontré le patient, mais attendent systématiquement les résultats des examens complémentaires pour en être certains. Ils sont loin d’être « objectifs » dans la façon dont ils traitent les données de leur environnement et craignent toujours le pire.
Conclusion
La modélisation de l’expertise en médecine d’urgence est susceptible d’aider les praticiens et les enseignants à mieux comprendre l’origine des erreurs de prise de décision dans le domaine de l’urgence.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
ICAPS (Intervention Centred on Adolescents' Physical activity and Sedentary behaviour) is aimed at preventing excessive weight gain and cardiovascular risk in adolescents by promoting physical ...activity (PA) with an emphasis on recreational and daily-life PA, with a lifelong perspective.
Randomized study designed to last for four years. Study cohort constituted of 954 first-level students (91% of eligible pupils), aged 11.7 ± 0.6 y (mean ± SD) from four pairs of schools randomly selected in eastern France, after sociogeographical stratification. In each pair, intervention status was randomised at school-level.
The program, not limited to school settings, involves multiple partners with three objectives: 1) changing attitudes through debates and access to attractive activities during breaks and after-school hours, 2) encouraging social support, 3) providing environmental conditions that enable PA. Adapted times and places, open participation, emphasis on fun, meeting with others and absence of competitive aspects are used to reduce usual barriers to PA. Accessibility and safety are permanent concerns.
Prevalence of overweight was 23.7%. High participation rates were attained (50% participated in at least one weekly activity). At six-month, the proportion of intervention adolescents not performing supervised PA out of academic PA was reduced by half (36% to 17% vs 42% to 42% in controls P < 10
-4); the proportion of those spending > 3 h/day in sedentary occupations decreased (34% to 28% vs 27% to 36%; P < 10
-4).
These data demonstrate the feasibility of implementing a multilevel PA intervention program in adolescents. Six-month results document increased PA and decreased sedentary behaviour.
ICAPS : programme de promotion de l'activité physique ciblant différents niveaux d'intervention chez l'adolescent
Le but d'ICAPS (Intervention Centrée sur l'Activité Physique et le comportement Sédentaire) est de prévenir l'excès de poids et le risque cardiovasculaire chez des adolescents, en favorisant l'activité physique (AP) pendant les loisirs mais aussi dans la vie quotidienne, avec des objectifs à long terme.
Étude randomisée, prévue sur quatre ans. La cohorte comprend 954 élèves de sixième (91 % des adolescents éligibles), âgés de 11,7 ans ± 0,6 à l'inclusion, provenant de 4 paires de collèges tirés au sort dans le Bas-Rhin après stratification sur le niveau socio-géographique. Dans chaque paire, le statut intervention ou témoin est randomisé à l'échelon du collège.
L'intervention qui requiert des partenaires multiples a trois objectifs :
1)
changer les connaissances et les attitudes au moyen des débats et des activités proposées durant les récréations et après les cours,
2)
encourager le soutien social, 3) fournir des conditions environnementales qui favorisent un mode de vie actif. Des lieux et des horaires adaptés, une participation libre, la mise en avant des aspects plaisir, la rencontre avec les autres et l'absence d'esprit de compétition sont les moyens utilisés pour diminuer les obstacles habituels à la pratique d'AP. L'accessibilité des activités ainsi que la sécurité ont été des préoccupations constantes.
La prévalence du surpoids est de 23,7 %. Le taux de participation aux activités est élevé (50 % pratiquent au moins une AP hebdomadaire). Après 6 mois, la proportion des adolescents « intervention » ne pratiquant pas d'AP encadrée en dehors des cours d'éducation physique a été réduite de moitié (36 % à 17 % vs 42 % à 42 % chez les sujets témoins; P < 10
-4) et la proportion de ceux consacrant plus de 3h/j à des occupations sédentaires a baissé (34 % à 28 % vs 27 % à 36 % chez les témoins; P < 10
-4).
Ces données démontrent qu'il est possible de mettre en place un programme qui vise à promouvoir l'AP chez des adolescents. Les résultats à 6 mois montrent une augmentation du niveau d'AP et une baisse des comportements sédentaires.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
Patient's triage is a key element of mass-casualty incidents (MCIs) response, although performance of healthcare professionals in triage proved to be poor. It was assessed if specific teaching ...methods based on pattern recognition skill development can help healthcare students to improve their performance in triage.
128 medical and nursing students have been assessed while performing triage during disaster medicine exercises. Half of them (group 1) had previously been involved in a standard curriculum. The remaining half (group 2) benefited from specific teaching methods based on pattern recognition skill development.
Performance of group 2 was significantly higher compared with group 1 (p<0.01). Group 2 had a lower overtriage rate.
Disaster medicine courses based on pattern recognition skill development improve triage performance of healthcare students during simulated MCI. This study may have a high impact on healthcare students and professionals' education in the perspective of MCIs preparedness and response.
Population-based studies directed at promoting physical activity in youth have shown limited success in obesity prevention. To assess whether an intervention integrating environmental changes to ...induce sustained changes in physical activity, prevents overweight in adolescents. Four-year randomized trial started in 2002 in eight middle schools of Eastern France. The intervention, randomized at school level, was designed to promote physical activity by changing attitudes through debates and attractive activities, and by providing social support and environmental changes encouraging physical activity. Nine hundred and fifty four 12-year-old six-graders. Body mass index (BMI), body composition, physical activity by questionnaire, plasma lipids and glucose, insulin resistance. Intervention students had a lower increase in BMI (P=0.01) and age- and gender-adjusted BMI (P<0.02) over time than controls. The differences across groups of the age- and gender-adjusted BMI changes (95% confidence interval (CI)) were -0.29 (-0.51; -0.07) kg/m2 at 3 years, -0.25 (-0.51; 0.01) kg/m2 at 4 years. An interaction with baseline weight status was noted. The intervention had a significant effect throughout the study in initially non-overweight adolescents (-0.36 (-0.60;-0.11) kg/m2 for adjusted BMI at 4 years), corresponding to a lower increase in fat mass index (P<0.001). In initially overweight adolescents, the differences observed across groups at 2 years (-0.40 (-0.94; 0.13) kg/m2 for adjusted BMI) did not persist over time. At 4 years, 4.2% of the initially non-overweight adolescents were overweight in the intervention schools, 9.8% in the controls (odds ratio=0.41 (0.22; 0.75); P<0.01). Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised physical activity (P<0.0001), a decrease of TV/video viewing (P<0.01) and an increase of high-density cholesterol concentrations (P<0.0001). Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents. Our study provides evidence that prevention of obesity in youth is feasible.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To evaluate the 6-month impact of a physical activity (PA) multilevel intervention on activity patterns and psychological predictors of PA among adolescents. The intervention was directed at changing ...knowledge and attitudes and at providing social support and environmental conditions that encourage PA of adolescents inside and outside school.
Randomised, controlled ongoing field trial (ICAPS) in middle-school's first-level adolescents from eight schools selected in the department of the Bas-Rhin (Eastern France) with a cohort of 954 adolescents (92% of the eligible students) initially aged 11.7+/-0.6 y. The 6-month changes in participation in leisure organised PA (LOPA), high sedentary (SED) behaviour (>3 h/day), self-efficacy (SELF) and intention (INTENT) towards PA were analysed after controlling for baseline measures and different covariables (age, overweight, socioprofessional occupation), taking into account the cluster randomisation design.
The proportion of intervention adolescents not engaged in organised PA was reduced by 50% whereas it was unchanged among control students. After adjustment for baseline covariables, LOPA participation significantly increased among the intervention adolescents (odds ratio (95% confidence interval) (OR)=3.38 (1.42-8.05) in girls; 1.73 (1.12-2.66) in boys), while high SED was reduced (OR=0.54 (0.38-0.77) in girls; 0.52 (0.35-0.76) in boys). The intervention improved SELF in girls, whatever their baseline LOPA (P<10(-4)) and INTENT in girls with no baseline LOPA (P=0.04). SELF tended to improve in boys with no baseline LOPA, without reaching statistical significance. When included in the regression, follow-up LOPA was associated with improvement of SELF in girls (P=0.02) and of INTENT in girls with no baseline PA (P<0.02). The intervention effect was then attenuated.
After 6 months of intervention, ICAPS was associated with a significant improvement of activity patterns and psychological predictors, indicating a promising approach for modifying the long-term PA level of adolescents.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objectives: Little is known about how emergency physicians reason in order to make diagnostic and therapeutic decisions. Yet, reasoning errors are the main cause of diagnostic errors in the context ...of the clinical practice. This article brings to the attention of emergency physicians and emergency medicine teachers the main results of a vast study carried out from 2010 to 2015 within a multidisciplinary team that brought together researchers from several countries. The project aimed at modeling expertise in emergency medicine. Methods: We carried out a multicenter prospective observational study based on a qualitative approach. We conducted interviews with expert emergency physicians until data saturation. The interviews focused on the recent management of an emergency situation. They were underpinned by the video recording of the situation according to the physicians' own point of view perspective. Results: The interviewed emergency physicians mainly used their intuition, forged very early on the basis of two to four clinical and contextual data. They often generate the correct diagnostic even before meeting the patient, but systematically wait for the results of the complementary examinations to be certain. They are far from being ``objective'' when they deal with data from their environment and always worry about the worst. Conclusion: The modeling of expertise in emergency medicine is likely to help practitioners and teachers to better understand the causes of decision-making errors in the field of emergency medicine.
Correction to: Int J Obes advance online publication, 15 July 2008; doi:10.1038/ijo.2008.99 Since the publication of the above paper, the authors have noticed an omission in the legend of Figure 2 ...and they wish to modify it slightly. The amended Figure 2 is reproduced below. The authors apologize for the errors.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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