Abstract
Background
Completing a master thesis (MT) is mandatory in many undergraduate curricula in medicine but a specific educational framework to guide the supervisor-student relationship during ...the MT has not been published. This could be helpful to facilitate the MT process and to more effectively reach the learning objectives related to science education in medicine. An attractive model for this purpose is the ‘Educational Alliance’ (EA), which focusses on the three components ‘
clarity and agreement on (a) goals, (b) tasks and (c) relationship & roles
’. This study investigated factors that can either facilitate or hinder the process of MTs, and related these to the components of the EA.
Methods
We conducted semi-structured face-to-face interviews with 20 students and – separately – with their 20 corresponding supervisors, after the MT had been accepted. The interviews included open questions on factors facilitating or hindering the success of the MT. Audio recordings of the interviews were anonymized and transcribed, and then analysed by qualitative content analysis. Also, quantitative data were gathered on satisfaction with the MT process and the supervisory quality (using Likert-type questions).
Results
We were able to analyse all 40 interviews, related to 20 MTs. From the transcripts, we extracted 469 comments related to the research question and categorized these into the four main categories (a) ‘Preparation’, (b) ‘Process’, (c) ‘Atmosphere’, (d) ‘Value of the MT’. Interviewees highlighted the importance of a careful preparation phase, clear expectations, a clear research plan, thorough and timely feedback, mutual agreement on timelines, and a positive working atmosphere. Each of these factors could be brought in line with the three components of the EA framework:
agreement and clarity of goals, tasks, relationships & roles.
Satisfaction with the MT process was rated 8.75 ± 1.22 SD (of 10) points by supervisors, and 7.80 ± 1.61 SD points by students, while supervision quality was rated
+
1.51 ± 0.63 SD (scale from − 2 to + 2) by supervisors, and
+
1.26 ± 0.93 SD by students.
Conclusion
We propose the EA framework as a useful guidance for students, supervisors, and the university towards conducting successful MTs in medicine. Based on the findings, we provide specific recommendations for students, supervisors, and university.
Individuals may show different responses to stressful events. Here, we investigate the neurobiological basis of stress resilience, by showing that neural responsitivity of the noradrenergic locus ...coeruleus (LC-NE) and associated pupil responses are related to the subsequent change in measures of anxiety and depression in response to prolonged real-life stress. We acquired fMRI and pupillometry data during an emotional-conflict task in medical residents before they underwent stressful emergency-room internships known to be a risk factor for anxiety and depression. The LC-NE conflict response and its functional coupling with the amygdala was associated with stress-related symptom changes in response to the internship. A similar relationship was found for pupil-dilation, a potential marker of LC-NE firing. Our results provide insights into the noradrenergic basis of conflict generation, adaptation and stress resilience.
Abstract Background An important predictor of outcomes from out-of-hospital cardiac arrest (OOHCA) is bystander resuscitation, but in industrialised nations this is undertaken only in 15–50%. To ...explore reasons for this low response rate we analysed bystander perceptions during the victim's collapse, and methods used to assess cardiac arrest. Methods Over a 12-month period we prospectively investigated all dispatches for witnessed cardiac arrest of two physician-staffed emergency medical service (EMS) units within a western European metropolitan area (Berlin, Germany). On scene the bystander was identified by the EMS physician and approached to have a semi-structured interview in the following days. Results Out of 201 eligible responses, 138 bystanders could be interviewed (68.7%). 63 (45.3%) of these bystanders did not detect cardiac arrest. 36 bystanders (25.9%) spontaneously reported a “bluish colour” of the patient's head or body which occurred “unexpectedly”. 39 persons (28.1%) reported abnormal breathing. Assessment of breathing was not undertaken in 27.0%, nor of circulation in 29.0%. If circulation was assessed pulse check was performed in 93.4%. Conclusion In this sample of interviewed bystanders of OOHCA, almost half of the arrests were not detected. This might be a reason for the low rate of bystander resuscitation. Common bystander perceptions of arrest presence included “bluish skin colour” and abnormal breathing of the victim. These findings indicate that improvement of perception capabilities should be incorporated as a major learning objective into lay basic life support training. In addition, information regarding skin colour may be of value in dispatch protocols.
Outcome from out-of-hospital cardiac arrest (OHCA) highly depends on bystander cardiopulmonary resuscitation (CPR) with high-quality chest compressions (CCs). Precondition is a supine position of the ...victim on a firm surface. Until now, no study has systematically analysed whether bystanders of OHCA apply appropriate positions to victims and whether the position is associated with a particular outcome.
Prospective observational cohort study.
Metropolitan emergency medical services (EMS) serving a population of 400 000; dispatcher-assisted CPR was implemented. We obtained information from the first EMS vehicle arriving on scene and matched this with data from semi-structured interviews with witnesses of the arrest.
Bystanders of all OHCAs occurring during a 12-month period (July 2006-July 2007). From 201 eligible missions, 200 missions were fully reported by EMS. Data from 138 bystander interviews were included.
Proportion of positions suitable for effective CCs; related survival with favourable neurological outcome at 3 months.
Positioning of victims at EMS arrival was 'supine on firm surface' in 64 cases (32.0%), 'recovery position (RP)' in 37 cases (18.5%) and other positions unsuitable for CCs in 99 cases (49.5%). Survival with favourable outcome at 3 months was 17.2% when 'supine position' had been applied, 13.5% with 'RP' and 6.1% with 'other positions unsuitable for CCs'; a statistically significant association could not be shown (p=0.740, Fisher's exact test). However, after 'effective CCs' favourable outcome at 3 months was 32.0% compared with 5.3% if no actions were taken. The OR was 5.87 (p=0.02).
In OHCA, two-thirds of all victims were found in positions not suitable for effective CCs. This was associated with inferior outcomes. A substantial proportion of the victims was placed in RP. More attention should be paid to the correct positioning of victims in OHCA. This applies to CPR training for laypersons and dispatcher-assisted CPR.
Abstract Background Training requirements to perform safe prehospital endotracheal intubation (ETI) are not clearly known. This study aimed to determine differences in ETI performance between ...‘proficient performers’ and ‘experts’ according to the Dreyfus & Dreyfus framework of expertise. As a model for ‘proficient performers’ EMS physicians with a clinical background in internal medicine were compared to EMS physicians with a background in anaesthesiology as a model for ‘experts’. Methods Over a one-year period all ETIs performed by the EMS physicians of our institution were prospectively evaluated. ‘Proficient performers’ and ‘experts’ were compared regarding incidence of difficult ETI, ability to predict difficult ETI, and decision for ETI. Results Mean years of professional experience were similar between the physician groups, but the median ETI experience differed significantly with 18/year for ‘proficients’ and 304/year for ‘experts’ ( p < 0.001). ‘Proficient performers’ intubated 130 of their 2170 treated patients (6.0%), while ‘experts’ did so in 146 of 1809 cases (8.1%, p = 0.01 for difference). The incidence of difficult ETI was 17.7% for ‘proficient performers’, and 8.9% for ‘experts’ ( p < 0.05). In 4 cases ETI was impossible, all managed by ‘proficient performers’, but all patients could be ventilated sufficiently. Unexpected difficult ETI occurred in 6.1% for ‘proficient performers’, and 2.0% for ‘experts’ ( p = 0.08). Conclusions In a prehospital setting ‘expert’ status was associated with a significantly lower incidence of ‘difficult ETI’ and a higher proportion of ETI decisions. In addition, ability to predict difficult ETI was higher, although non-significant. There was no difference in the incidence of impossible ventilation.
Clinical teaching is essential in preparing trainees for independent practice. To improve teaching quality, clinical teachers should be provided with meaningful and reliable feedback from trainees ...(bottom-up feedback) based on up-to-date educational concepts. For this purpose, we designed a web-based instrument, "Swiss System for Evaluation of Teaching Qualities" (SwissSETQ), building on a well-established tool (SETQsmart) and expanding it with current graduate medical education concepts. This study aimed to validate the new instrument in the field of anaesthesiology training.
Based on SETQsmart, we developed an online instrument (primarily including 34 items) with generic items to be used in all clinical disciplines. We integrated the recent educational frameworks of CanMEDS 2015 (Canadian Medical Educational Directives for Specialists), and of entrustable professional activities (EPAs). Newly included themes were "Interprofessionalism", "Patient centredness", "Patient safety", "Continuous professional development', and "Entrustment decisions". We ensured content validity by iterative discussion rounds between medical education specialists and clinical supervisors. Two think-aloud rounds with residents investigated the response process. Subsequently, the instrument was pilot-tested in the anaesthesia departments of four major teaching hospitals in Switzerland, involving 220 trainees and 120 faculty. We assessed the instrument's internal structure (to determine the factorial composition) using exploratory factor analysis, internal statistical consistency (by Cronbach's alpha as an estimate of reliability, regarding alpha >0.7 as acceptable, >0.8 as good, >0.9 as excellent), and inter-rater reliability (using generalisability theory in order to assess the minimum number of ratings necessary for a valid feedback to one single supervisor).
Based on 185 complete ratings for 101 faculty, exploratory factor analysis revealed four factors explaining 72.3% of the variance (individual instruction 33.8%, evaluation of trainee performance 20.9%, teaching professionalism 12.8%; entrustment decisions 4.7%). Cronbach's alpha for the total score was 0.964. After factor analysis, we removed one item to arrive at 33 items for the final instrument. Generalisability studies yielded a minimum of five to six individual ratings to provide reliable feedback to one supervisor.
The SwissSETQ possesses high content validity and an "excellent" internal structure for integrating up-to-date graduate medical education concepts. Thereby, the tool allows reliable bottom-up feedback by trainees to support clinical teachers in improving their teaching. Transfer to disciplines other than anaesthesiology needs to be further explored.
To compare the effectiveness of Peyton’s four-step approach for teaching resuscitation skills with alternative approaches.
For this systematic review, we followed the PICOST format (population, ...intervention, comparison, outcome, study design, timeframe) using Peyton’s four-step approach as the standard. We included all studies analyzing skills training related to resuscitation and First Aid in any educational setting. Eligible were randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, published conference abstracts, and case series where n ≥ 5). We excluded unpublished results (e.g. trial protocols), commentaries, editorials, reviews. Medline, Embase, PsycINFO, ERIC, CINAHL, and Cochrane were searched from inception until November 10, 2020 (updated November 25, 2022) for publications in all languages as long as there was an English abstract. Titles and abstracts of the papers retrieved were screened, and eligible publications were analysed in full text. From the final set of papers, data were extracted into a spreadsheet, subsequently risk of bias assessment was performed (using RoB2 and ROBINS-I), and the certainty of evidence (using GRADE) for each paper was assessed. Screening of studies, data extraction, risk-of-bias assessment, and assessment of certainty of evidence were all performed by two independent researchers. This review was conducted in adherence with PRISMA standards and was registered with PROSPERO (CRD42023377398).
Overall, the search identified 2,574 studies from which 17 were included in the final analysis (14 RCTs, and 3 non-RCTs). The studies involved a total of 2,906 participants from various populations (from lay persons to health care professionals) and analysed nine different resuscitation skills being taught (ranging from chest compressions to needle cricotomy). The alternative teaching approaches ranged from two-steps to five-steps with various modifications of single steps. High methodological and clinical heterogeneity precluded a meta-analysis from being conducted. The risk of bias assessment showed considerable variation between the studies ranging from ‘low’ to ‘serious’. Across all studies, certainty of evidence was rated as very low due to imprecision and inconsistency. Overall, 14 out of 17 studies showed no difference in skill acquisition or retention when comparing Peyton’s four steps to other stepwise approaches.
Very low certainty evidence suggest that Peyton’s four-step approach was not more effective in resuscitation skills training compared to alternative approaches.
None.
Sudden cardiac arrest is a major contributor to avoidable deaths in Europe. Immediate initiation of basic life support (BLS) by lay bystanders is among the most successful strategies in its ...treatment. Despite the fact that more than half of all cardiac arrests are witnessed in a number of European countries, layperson resuscitation is initiated in only one-fifth of all cases. One strategy to promote bystander BLS is to establish cardiac resuscitation training in schools. BLS instructions for schoolchildren – including the use of automatic external defibrillators (AEDs) – have been shown to be feasible independently of the children's age or physical ability. Nonetheless, it appears reasonable to implement age-adjusted curricula. The earlier in the course of life-long learning BLS instruction begins, the more sustainable training may be.
As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is ...of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines.
Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach.
Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients.
In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.
To compare the effectiveness of cognitive aid use during resuscitation with no use of cognitive aids on cardiopulmonary resuscitation quality and performance.
This systematic review followed the ...PICOST format. All randomised controlled trials and non-randomised studies evaluating cognitive aid use during (simulated) resuscitation were included in any setting. Unpublished studies were excluded. We did not include studies that reported cognitive aid use during training for resuscitation alone. Medline, Embase and Cochrane databases were searched from inception until July 2019 (updated August 2022, November 2023, and 23 April 2024). We did not search trial registries. Title and abstract screening, full-text screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I), and certainty of evidence (using GRADE) were performed by two researchers. PRISMA reporting standards were followed, and registration (PROSPERO CRD42020159162, version 19 July 2022) was performed. No funding has been obtained.
The literature search identified 5029 citations. After removing 512 duplicates, reviewing the titles and abstracts of the remaining articles yielded 103 articles for full-text review. Hand-searching identified 3 more studies for full-text review. Of these, 29 studies were included in the final analysis. No clinical studies involving patients were identified. The review was limited to indirect evidence from simulation studies only. The results are presented in five different populations: healthcare professionals managing simulated resuscitations in neonates, children, adult advanced life support, and other emergencies; as well as lay providers managing resuscitations. Main outcomes were adherence to protocol or process, adherence to protocol or process assessed by performance score, CPR performance and retention, and feasibility of chatbot guidance. The risk of bias assessment ranged from low to high. Studies in neonatal, paediatric and adult life support delivered by healthcare professionals showed benefits of using cognitive aids, however, some studies evaluating resuscitations by lay providers reported undesirable effects. The performance of a meta-analysis was not possible due to significant methodological heterogeneity. The certainty of evidence was rated as moderate to very low due to serious indirectness, (very) serious risk of bias, serious inconsistency and (very) serious imprecision.
Because of the very low certainty evidence from simulation studies, we suggest that cognitive aids should be used by healthcare professionals during resuscitation. In contrast, we do not suggest use of cognitive aids for lay providers, based on low certainty evidence.
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