Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis ...simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant’s heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N–N interval (SDNN), Root mean square standard deviation of the N–N interval (RMSSD), Percentage of successive R–R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.
Over the past decade technological advances in the realm of ultrasound have allowed what was once a cumbersome and large machine to become essentially hand-held. This coupled with a greater ...understanding of lung sonography has revolutionized our bedside assessment of patients. Using ultrasound not as a diagnostic test, but instead as a component of the physical exam, may allow it to become the stethoscope of the 21st century.
Healthcare teams include both leaders and followers, with followers making up the majority of the healthcare team. There are five followership styles which have been described by Kelly (1992) based ...on critical thinking and active engagement. We aim to explore if a relationship exists between followership style and burnout, and also with job satisfaction of followers within the critical care setting. Additionally, we aim to quantify the distribution of followership types amongst followers within the critical care setting.
Participants were recruited in person at random to participate in a single centered, cross sectional, four-part survey to determine their followership type (Kelly followership type), burnout (Maslach Burnout Inventory) and job satisfaction (Brayfiled-Rothe Survey and Work and Meaning Inventory). Correlations between followership type and burnout as well as followership type and job satisfaction were then determined.
A total of 64 participants (27 residents and 37 critical care nurses) took part in the study. There was a weak-moderate correlation between independent critical thinking and personal accomplishment (R = 0.297), and moderate correlation to meaningful work (R = 0.390), and job satisfaction (R = −0.300). Active engagement was moderately correlated with personal accomplishment (R = 0.302), meaningful work (R = 0.448) and job satisfaction (R = −0.418). Neither independent critical thinking nor active engagement showed significant correlation with depersonalization and emotional exhaustion subscales. Most participants were characterized into effective/exemplary followership type with no statistically significant differences between nurses and residents.
This research shows that by creating an environment which promotes critical thinking and active engagement, nurses and residents may display less burnout, and enhanced job satisfaction.
Abstract Background Considerable resources have been invested in low- and high-fidelity simulators in surgical training. To our knowledge, no investigation has compared the 2 head to head for ...operative assessment purposes. The purpose of this study was to assess the Fundamentals of Laparoscopic Surgery (FLS) low-fidelity video trainer and LapVR (high-fidelity virtual-reality simulator) for (1) construct and (2) predictive validity using a human cholecystectomy model. Methods Twenty-six participants performed tasks from the FLS program and the LapVR simulator as well as a human laparoscopic cholecystectomy. Performance was evaluated using FLS and LapVR metrics and the Objective Structured Assessment of Technical Skills previously validated rating scale. Results Construct and predictive validity were strongly demonstrated for FLS tasks but only incompletely for LapVR. Conclusions Efforts should be focused on using the well-validated lower-cost FLS video trainer for assessment of laparoscopic skills. The high-cost LapVR remains experimental in resource-constrained training programs.
Abstract Background Ultrasound assessment of optic nerve sheath diameter (ONSD) has been suggested as a non-invasive measure of intracranial pressure. Numerous small studies suggest its validity; ...however, discrepancy exists around normal values for ONSD. In this study we sought to define a normal value range for ONSD in a population of healthy adult volunteers. Methods ONSD was measured in healthy adult volunteers and a normal range was defined using descriptive statistics. A regression analysis was used to determine relationship between ONSD measurements and sex, age, height and weight. Results One hundred twenty adults were recruited (age 18-65 mean 29.3) with 55 male and 65 female subjects. Mean ONSD was 3.68 mm (95% confidence interval CI, 2.85-4.40). Upon regression analysis, mean ONSD did not vary with age, weight, or height but did vary with sex. Mean ONSD measurements for men were 3.78 mm (95% CI, 3.23-4.48) compared with 3.60 mm (95% CI, 2.83-4.11) for women. Conclusion This study has defined the range of ONSD in a healthy cohort of volunteers. The lack of relationship to age, weight and height is similar to other studies but this is the first study to find a difference depending on sex suggesting the possible need for separate reference ranges for men and women.
Abstract Background We previously reported on a pilot trauma multidisciplinary crisis resource course titled S.T.A.R.T.T. (Simulated Trauma and Resuscitative Team Training). Here, we study the ...course's evolution. Methods Satisfaction was evaluated by postcourse survey. Trauma teams were evaluated using the Ottawa global rating scale and an Advanced Trauma Life Support primary survey checklist. Results Eleven “trauma teams,” consisting of physicians, nurses, and respiratory therapists, each completed 4 crisis simulations over 3 courses. Satisfaction remained high among participants with overall mean satisfaction being 4.39 on a 5-point Likert scale. As participants progressed through scenarios, improvements in global rating scale scores were seen between the 1st and 4th (29.8 vs 36.1 of 42, P = .022), 2nd and 3rd (28.2 vs 34.6, P = .017), and 2nd and 4th (28.2 vs 36.1, P = .003) scenarios. There were no differences in Advanced Trauma Life Support checklist with mean scores for each scenario ranging 11.3 to 13.2 of 17. Conclusions The evolved Simulated Trauma and Resuscitative Team Training curriculum has maintained high participant satisfaction and is associated with improvement in team crisis resource management skills over the duration of the course.
Research in healthcare leadership has focused on leaders. In contrast, organizational success may be more influenced by followers. Kelley described five followership styles based on two ...characteristics: active engagement and independent critical thinking. We examined the literature on the association between followership style and workplace outcomes.
Articles from MEDLINE, CINAHL, and EMBASE were searched. Given the paucity of studies, we expanded our search to non-healthcare databases. Two reviewers identified all studies examining followership styles and their association with job satisfaction and/or performance outcomes. Included studies were evaluated using the GRADE approach.
We identified one article on followership for every sixty articles on leadership in the medical literature. Fourteen observational studies on followership were included in our analysis. Outcomes ranged from the individual to the organizational level. No synthesized analysis was possible due to heterogeneity. Followership styles with greater active engagement and independent critical thinking were associated with increased job satisfaction, decreased burnout, and workplace performance metrics.
There is a dearth of studies on followership. The literature suggests that followership characterized by greater independence is associated with positive outcomes. Given the importance of teamwork in the critical care environment, we should prioritize understanding of this important variable.
•Followership is an important but understudied concept in healthcare leadership research•For every one research article on followership, there are sixty articles on leadership in the medical literature•The Kelley model describes five followership styles based on attributes of active engagement and independent critical thinking•Our review shows that followership styles with greater engagement and independence are associated with positive outcomes
Abstract Background Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform “classic” general surgery procedures, but they are also often ...expected to be competent in other surgical disciplines. Methods Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Results Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. Conclusions More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons.
Introduction
Past education literature has shown benefits for random practice schedules (termed contextual interference) for skills retention and transfer to novel tasks. The purpose of fundamentals ...of laparoscopic surgery (FLS) training is to develop skills in simulation and transfer to new in vivo intraoperative experiences. The study objective was to assess whether individuals trained over a fixed number of trials in the FLS tasks would outperform untrained controls on an unpracticed previously validated bile duct cannulation task and scoring system and to determine whether random training schedules conferred any relative advantage.
Methods
44 trainees with no laparoscopic experience were recruited to participate. 35 were randomized to practice the FLS tasks using either a blocked or random training schedule. Nine were randomized to no additional training (controls). Participant performance was measured throughout training to monitor skills acquisition and were then tested on an unpracticed bile duct cannulation simulation task 4 to 6 weeks later. Outcomes included previously validated FLS scores and hand–motion analyses.
Results
All 44 participants completed the study. Trained individuals in both groups showed significant improvements in all FLS tasks after training. There were no differences between groups in performance on the cannulation task median scores (Blocked: 89.8 IQR:37.6; Random: 83.2 32.3; Control: 83.6 19.1;
p
= 0.955), number of hand motions (Blocked: 42.5 IQR:130.3; Random: 75.3 111.3; Control: 63.0 71.8;
p
= 0.912), or distance traveled by participants hands (Blocked: 2.0 m IQR:5.8; Random: 3.8 8.9; Control: 2.6 2.5;
p
= 0.816). Cannulation task performance had no correlation with total FLS performance,
R
2
linear = 0.014,
p
= 0.445.
Conclusions
Skills acquired from conventional FLS tasks did not effectively transfer to a laparoscopic bile duct cannulation task. Neither blocked nor random practice schedules conferred a relative advantage. These findings provide evidence that cannulation is a distinct skill from what is taught and assessed in FLS.
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