Improving toxicology knowledge in preclinical medical students using high-fidelity patient simulators.

BACKGROUND: Superior patient care and optimal physician training are often mutually elusive in the Emergency Department setting. Highfidelity patient simulators (HFPSs) are being used with increasing frequency in the training of medical students (MS) because they enable students to develop and refine medical competency in a non-threatening and safe environment. However, learner outcomes using HFPSs in this setting have not been well studied. OBJECTIVES: The objective of this pilot study was to determine the effectiveness of HFPSs in simulation (SIM) training as a learning tool for preclinical second-year MS to further increase their toxicology knowledge. METHODS: Second-year MS at a Problem Based Learning (PBL) medical school received a PBL toxicology teaching session in the middle of the semester. One week later, the students participated in a SIM exercise based on issues taken from the PBL case. The SIM exercise required that students address learning issues such as identifying abnormal findings, ordering tests, and, ultimately, initiating treatment on a full-scale HFPS mannequin. A supervised on-line test consisting of 10 multiple choice questions regarding the student's understanding of the learning issues was completed before the PBL class and directly before and after the SIM to determine the effectiveness of the HFPS use. Immediate video-assisted feedback was provided by emergency medicine attendings. RESULTS: Use of HFPSs during SIM exercises and in combination with PBL significantly increased toxicology knowledge in secondyear MS as determined by the improvement of on-line test scores (% correct answers) from 59% before PBL / before SIM to 69% after PBL / before SIM to 80% after PBL / after SIM. CONCLUSION: This study suggests that HFPS may be a valuable tool in helping to improve toxicology knowledge in second-year MS at a key transition period prior to beginning clerkship experiences. Incorporation of HFPS into PBL curricula may also be beneficial to MS in other areas of study where interactive learning could assist in evoking emotional realism while also enhancing critical thinking and acquisition of knowledge thereby facilitating the transition from theory to practice.

Preferred smoking cessation methods for Asian or Pacific Islander household smokers who live with hospitalized children.

INTRODUCTION: A qualitative study was conducted to determine preferred smoking cessation methods among Asian or Pacific Islander (API) smokers who live with hospitalized children. This study occurred in a children's hospital where a new cessation program would be developed. METHODS: Twenty-six API smokers who live with children admitted to the hospital were interviewed and tape-recorded. Responses to survey questions were transcribed, categorized, and analyzed. RESULTS: 73% were interested in quitting, 34% within the next 30 days. Few would independently use the quit-line (31%) or attend group classes (4%). However, if offered during their child's hospitalization, 52% would sign up for individualized counseling and 29% would attend group sessions. Respondents believed advice would be helpful from their physician (71%), child's pediatrician (65%, nurse (64%), respiratory therapist (65%), or smoking cessation counselor (75%). CONCLUSIONS: The majority of API smokers were interested in quitting and receptive to one-on-one counseling. Advice would be helpful from any healthcare professional.

Improving medical student toxicology knowledge and self-confidence using mannequin simulation.

BACKGROUND: Learning medicine without placing patients at increased risk of complications is of utmost importance in the medical profession. High-fidelity patient simulators can potentially achieve this and are therefore increasingly used in the training of medical students. Preclinical medical students have minimal exposure to clinical rotations and commonly feel anxious and apprehensive when starting their clinical years. OBJECTIVES: The objective of this pilot study was to determine if toxicology knowledge and confidence of preclinical second-year medical students could be augmented with simulation training. METHODS: We designed and implemented a simulation exercise for second-year medical students to enhance learning of Basic Life Support, toxidromes, and management of a semiconscious overdose victim. Groups of 5-6 students were tasked to identify abnormal findings, order tests, and initiate treatment on a mannequin. Faculty observers provided video-assisted feedback immediately afterwards. On-line pre- and posttests were completed in the simulation lab before and after the exercise. RESULTS: This simulation exercise, completed by 52 students, increased test scores on average from 60% to 71% compared to a pre-test. Among the topics tested, students scored worst in identifying normal/abnormal vital signs. Mean confidence increased from 2.0 to 2.6 using a 5-point Likert scale (1-very low to 5-very high). CONCLUSION: This study suggests that simulation exercises for second-year medical students may be a valuable tool to increase knowledge and student self-confidence at a key transition period prior to beginning clerkship experiences. Further research is needed to prove long-term educational benefits of simulation interventions in the preclinical setting.

Parent-child reading interactions among English and English as a second language speakers in an underserved pediatric clinic in Hawai'i.

PURPOSE: The purpose of this study was to compare reading patterns between English-speaking and English as a Second Language (ESL) families in a health care setting in Hawai'i. METHODS: A cross-sectional study was performed at an underserved pediatric primary care clinic in Hawai'i. Caregivers of patients between the ages of 6 months to 5 years were asked questions regarding demographics and parent-child reading interactions. Respondents were categorized into English-speaking or ESL groups based on primary language spoken at home. Pearson chi2 tests and Fisher exact tests were performed to compare demographic differences, reading frequency, and reading attitudes between groups. RESULTS: One-hundred three respondents completed the survey Fifty percent were ESL. All ESL respondents were of Asian-Pacific Islander (API) or mixed Asian ethnicity. All Caucasians in the study (n = 9) were in the English-speaking group. Between the English-speaking (n = 52) and ESL (n = 51) groups, there were no significant statistical differences in age or gender of the child, reading attitudes, or parent's educational status. Parents in the ESL group read to their children significantly fewer days per week than their English-speaking counterparts, had significantly fewer books in the home, and lived significantly fewer years in the United States. CONCLUSION: The findings suggest that API immigrant families share similar attitudes about reading as English-speaking families in Hawai'i but have significantly fewer books in their household and read significantly less frequently Physicians working with API populations should be aware that immigrant children may have fewer reading interactions and should counsel parents on the importance of reading daily.

Smoking cessation counseling training for pediatric residents in the continuity clinic setting.

OBJECTIVE: To determine the effectiveness of a clinic-based smoking cessation counseling curriculum on pediatric resident confidence, knowledge, counseling skills, and provision of counseling. METHODS: Twenty-six residents at a pediatric residency program completed a new smoking cessation counseling curriculum as part of continuity clinic training. We assigned residents to 2 groups (study group, n = 12 vs control group, n = 14) on the basis of clinic site. We used a quasi-experimental, crossover design with pre- and posttests for each group. Control-group residents served as an initial control before the intervention crossover. Residents were tested at baseline and at completion of each group's intervention. Standardized patients measured resident provision of counseling and quality of counseling during resident continuity clinic. Knowledge and confidence were measured by a written exam and self-administered survey. Analysis of variance with a mixed design assessed overall group differences and group performances over time. RESULTS: There were no baseline differences between groups. Across time, there were significant differences between study-group and control-group residents for confidence (F [2, 48] = 11.82; P <.01), knowledge (F [2, 48] = 6.24; P <.01), and provision of counseling (F [2, 48] = 3.60, P <.05) but not counseling skills (F [2, 48] = 2.44; P <.10). After each group's intervention, their confidence, knowledge, counseling skills, and inclusion of counseling increased significantly (P <.01 for all). CONCLUSIONS: Our findings suggest that a clinic-based curriculum in smoking cessation counseling can significantly increase knowledge, confidence, counseling skills, and provision of counseling. Future research should evaluate the long-term impact of such curricula on resident counseling behavior and patient outcomes.