A metric-based analysis of structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation.

OBJECTIVES: In this study we aimed to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The purpose was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. DESIGN: An educational study. SETTING: Simulation centre in a medical school. PARTICIPANTS: 113 final-year medical students. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The secondary outcome was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. RESULTS: During phone calls to a senior colleague 30% of students did not positively identify themselves, 29% did not identify their role, 32% did not positively identify the recipient of the phone call, 59% failed to positively identify the patient, 49% did not read back the recommendations of their senior colleague and 97% did not write down the recommendations of their senior colleague. CONCLUSIONS: We identified a deficiency in our students skills to communicate relevant information via the telephone, particularly failure to repeat back and write down instructions. We suggest that this reflects a paucity of opportunities to practice this skill in context during the undergraduate years. The assumption that this skill will be acquired following qualification constitutes a latent error within the healthcare system. The function of undergraduate medical education is to produce graduates who are fit for purpose at the point of graduation.

A study of innovative patient safety education.

BACKGROUND: Medical error continues to significantly harm patients, notwithstanding the continued efforts to improve the situation over the past decade. We report a pilot project using high-fidelity simulation to integrate the World Health Organisation (WHO) patient safety curriculum into undergraduate medical education. METHODS: From the literature on avoidable medical error we developed a series of authentic clinical scenarios using a Clinical Skills Lab (CSL) and simulated patients to produce a high-fidelity simulated ward environment. The clinical challenges embody common day-to-day encounters experienced by newly graduated doctors. After participating, final-year medical students were given time to reflect on the experience, given feedback and completed a quantitative evaluation. RESULTS: Twenty final-year medical students completed the scenarios, and gave written feedback using a Likert scale (ranging from 1, strongly disagree, to 7, strongly agree). The responses showed 18 students agreed or strongly agreed that the session was valuable, all 20 would recommend the session to peers and 18 would be interested in attending further sessions. The students gave more mixed views of faculty feedback: 13 agreed or strongly agreed that this was useful, five were undecided and two were undecided or disagreed. CONCLUSION: With the caveats of a small sample size, first experience of high-fidelity simulation, the 'halo' effect in the evaluation, and with possible omissions from our evaluation, the students reported predominantly positively on the experience. We believe that the use of high-fidelity simulation in patient safety is a promising, safe and low-cost curricular development in undergraduate medical education. It is transferable worldwide and has the potential to improve patient safety outcomes by reducing medical error.

Efficacy of sub-Tenon's block using an equal volume of local anaesthetic administered either as a single or as divided doses. A randomised clinical trial.

BACKGROUND: Sub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery. Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with 1-2 ml of local anaesthetic. Hypothesis was that after first injection some of the volume injected may spill out and before second injection the effect of hyaluronidase has taken place and second volume injectate will have desired effect. METHODS: A prospective, randomised, control trial in which patients were randomly allocated to one of two groups. In group 1, single injection of 5 ml of local anaesthetic was injected. In group 2, 3 ml of the same anaesthetic solution was injected followed by application of gentle orbital pressure for 2 minutes. A further 2 ml of the same anaesthetic solution was injected through the same conjunctival incision. Measurement of movement in four quadrants of eye was done by the surgeon at 3 and 6 minutes. Intraocular pressure, chemosis, and subconjuctival haemorrhage were also measured. RESULTS: Significant differences at 3 minutes between groups for overall movement, medial, superior, and lateral quadrants occurred. At 6 minutes no significant group differences emerged for the overall movement or for any of four quadrants. CONCLUSION: Single injection of local anaesthesia for sub-Tenon's block with mixture of lignocaine with adrenaline, bupivacaine and hyaluronidase was found to be superior to provide akinesia of ocular muscles compared to divided dose given by two injections. No difference in groups in terms of haemorrhage, chemosis, patient's satisfaction and intraocular pressure was found. TRIAL REGISTRATION: Trial registration no-ISRCTN73431052.