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BACKGROUND: Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10-40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation. METHODS: This explanatory, sequential mixed-methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed ("missed"). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendations RESULTS: Chart audit included 255 patients (n=161, 63.1% female) seen in preadmission clinic between April 1 and April 30, 2019. 55.7% of patients had all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (50.0%, n=28, and 68.9%, n=82, respectively). Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (driver: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (driver: need to adapt a preoperative plan for a complicated postoperative course). CONCLUSIONS: Only 55.7% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients.
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BACKGROUND: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training. METHODS: A cross-sectional survey of medical learners was conducted between March 25-June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic. RESULTS: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety. CONCLUSIONS: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.
CONTEXTE: On s'attendait à ce que la pandémie de la COVID-19 ait des conséquences sur la formation médicale, mais les constats relatifs à son impact sur les étudiants en médecine demeurent anecdotiques et plutôt spéculatifs. L'objectif de cette étude était d'explorer l'étendue des premiers effets de la COVID-19 sur les étudiants en médecine dans le monde et d'examiner les tendances et les schémas qui se dégagent, quels que soient la région géographique ou le niveau d'études. MÉTHODES: Une enquête transversale sur les étudiants en médecine a été menée entre le 25 mars et le 14 juin 2020, peu après que l'Organisation mondiale de la santé ait déclaré que la COVID-19 était une pandémie. RÉSULTATS: Le sondage a été réalisé auprès de 6492 étudiants de 140 pays. La plupart des facultés de médecine ont retiré les apprenants de l'environnement clinique et adopté l'apprentissage en ligne, mais les étudiants ont exprimé des préoccupations quant à sa qualité, à la progression de la formation et à l'atteinte de divers jalons. Les résidents jugent qu'ils pourraient être plus utiles et s'inquiètent de l'avancement de leur carrière. Les apprenants se sentent généralement sous-utilisés et souhaitent s'engager cliniquement de manière plus significative; cependant, certains estiment qu'il n'est pas à propos de demander aux étudiants de contribuer aux soins de santé pendant une pandémie. Des écarts importants ont été relevés entre les différents niveaux de formation et les différentes régions géographiques en ce qui concerne la satisfaction face aux réponses organisationnelles, l'impact de la COVID-19 sur leur bien-être et l'anxiété chronique et réactionnelle. CONCLUSIONS: La perturbation du statu quo dans l'éducation médicale est perçue par les étudiants de tous les niveaux et de toutes les régions géographiques, mais davantage encore par les résidents, comme ayant affecté négativement et leur formation et leur bien-être. Ces résultats fournissent des aperçus empiriques préliminaires sur les domaines qui méritent des recherches futures et qui devraient être pris en compte dans la formulation des politiques actuelles et à venir.
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BACKGROUND: On March 11, 2020 the World Health Organization declared the novel coronavirus SARS-CoV-2 disease (COVID-19) a global pandemic. We sought to understand impact of COVID-19 on learner wellness at a large tertiary care academic institution to inform the future development of learner wellness interventions during the COVID-19 pandemic. METHODS: A cross-sectional, internet-based survey collected quantitative and qualitative data from learners April-June 2020. Descriptive statistics and univariate analyses were reported for quantitative data. Open-ended, qualitative responses were analyzed deductively using thematic analysis. RESULTS: Twenty percent of enrolled learners in that faculty of medicine (540/2741) participated including undergraduate [Bachelor's] students (25.7%), graduate [science] students (27.5%), undergraduate medical students (22.8%), and postgraduate resident physicians (23.5%). We found that learner wellness across all stages of training was negatively impacted and the ways in which learners were impacted varied as a result of their program's response to the COVID-19 pandemic. CONCLUSIONS: Learners in health sciences and medical education report worsening well-being because of the programs and the systems in which they function with the added burden of the COVID-19 pandemic. Future interventions would benefit from a holistic framework of learner wellness while engaging in systems thinking to understand how individuals, programs and respective systems intersect. The importance of acknowledging equity, diversity and inclusion, fostering psychological safety and engaging learners as active participants in their journey during a pandemic and beyond are key elements in developing wellness interventions.
CONTEXTE: Le 11 mars 2020, l'Organisation mondiale de la santé a déclaré que le nouveau coronavirus SRAS-CoV-2 (COVID-19) était pandémique. Nous avons tenté de cerner l'impact de la COVID-19 sur le bien-être des apprenants dans un grand centre universitaire de soins tertiaires afin d'étayer le développement futur d'interventions en faveur du bien-être des apprenants en contexte de pandémie. MÉTHODES: Une enquête transversale par sondage en ligne, menée entre les mois d'avril et juin 2020, a permis de recueillir des données quantitatives et qualitatives auprès des apprenants. Des statistiques descriptives et des analyses univariées ont été présentées comme données quantitatives. Les réponses ouvertes, qualitatives, ont été analysées de manière déductive par le biais d'une analyse thématique. RÉSULTATS: Vingt pour cent des étudiants de la faculté de médecine (540/2741) ont participé, dont 25,7 % étaient inscrits au premier cycle (baccalauréat), 27,5 % au deuxième cycle (sciences), 22,8 % au premier cycle en médecine et 23,5 % étaient résidents. Nous avons constaté que la pandémie a négativement affecté le bien-être des apprenants à tous les niveaux de formation et que les effets précis sur les étudiants pouvaient varier en fonction de la réponse de leur programme à la situation sanitaire. CONCLUSIONS: Les étudiants en médecine et en sciences de la santé signalent une détérioration de leur bien-être liée aux programmes et aux systèmes dans lesquels ils évoluent, auxquels s'ajoute le fardeau supplémentaire de la pandémie de la COVID-19. Il conviendrait de définir les interventions futures sur la base d'un cadre holistique du bien-être des apprenants tout en adoptant une réflexion systémique pour appréhender l'entrecroisement entre individus, programmes et systèmes. Reconnaître l'importance de l'équité, de la diversité et de l'inclusion, favoriser la sécurité psychologique et assurer la participation active des apprenants dans leur parcours pendant la pandémie et au-delà, constituent des éléments clés dans l'élaboration d'interventions au profit de leur bien-être.
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BACKGROUND: Advance care planning is the process of communicating and documenting a person's future health care preferences. Despite its importance, knowledge of advance care planning is limited, especially among the Islamic community. In addition, little is known about how the Islamic community views advance care planning in the context of their religious and cultural beliefs. OBJECTIVES: We aimed to increase knowledge of the importance of advance care planning, to improve health care provider and public knowledge, and to encourage dialogue between the community and health care providers. METHODS: We organized a community event and assembled a multi-disciplinary panel. Through a moderated discussion, the panel members offered their perspectives of advance care planning within a Muslim context. RESULTS: Approximately 100 individuals attended the event including community members, health care providers, medical students, and faith leaders. More than 90% of respondents rated the event as very good or excellent, found the session useful and were encouraged to reflect further on advance care planning. CONCLUSION: This event was successful in raising awareness about advance care planning within the Islamic community as well as educating health care providers on Islamic views. This model of community and health care provider engagement may also be beneficial for other faith groups wishing to discuss advance care planning within their respective religious and cultural contexts.
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BACKGROUND: The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. INTERVENTION: The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. METHODS: In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. KEY RESULTS: From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. CONCLUSIONS: MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.
Subject(s)
COVID-19 , Physicians , Canada , Humans , Pandemics , SARS-CoV-2 , WorkforceABSTRACT
A 62-year-old woman with coronavirus disease 2019 developed acute respiratory failure and cardiogenic shock in the setting of a systemic hyperinflammatory state and apparent ST-elevation myocardial infarction. Cardiac magnetic resonance imaging showed fulminant acute myocarditis with severe left ventricular dysfunction. Treatment with the recombinant interleukin-1 receptor antagonist anakinra and dexamethasone resulted in rapid clinical improvement, reduction in serum inflammatory markers, and a marked recovery in cardiac magnetic resonance--based markers of inflammation and contractile dysfunction. The patient was subsequently discharged from the hospital. Emerging evidence supports use of anti-inflammatory therapies, including anakinra and dexamethasone, in severe cases of coronavirus disease 2019.
Une femme de 62 ans atteinte de la COVID-19 a développé une insuffisance respiratoire aiguë et un choc cardiogène dans le contexte d'un état hyperinflammatoire général et d'un infarctus du myocarde avec élévation du segment ST apparent. L'imagerie par résonance magnétique cardiaque a révélé une myocardite aiguë fulminante accompagnée d'une dysfonction ventriculaire gauche sévère. Le traitement par l'anakinra, un antagoniste des récepteurs de l'interleukine 1 recombinant, et la dexaméthasone, a entraîné une amélioration clinique rapide, une diminution des marqueurs inflammatoires sériques et un rétablissement marqué selon les marqueurs de l'inflammation et de la dysfonction contractile à la résonance magnétique cardiaque. La patiente a par la suite reçu son congé de l'hôpital. De nouvelles données probantes militent en faveur de l'emploi de traitements anti-inflammatoires, comme l'anakinra et la dexaméthasone, dans les cas sévères de COVID-19.
