Training Tomorrow's Doctors to Safeguard the Patients of Today: Using Medical Student Simulation Training to Explore Barriers to Recognition of Elder Abuse.

In recognition of the fact that elder abuse is a global problem that doctors underrecognize and underreport, a simulation training session for undergraduate medical students was developed. The primary objective of this qualitative study was to examine barriers to and drivers of medical students making a diagnosis of elder abuse in simulated practice, with the goal of refining teaching methods and informing future teaching sessions for other clinical teachers. Third-year medical students (Newcastle University, United Kingdom) undertook a simulation scenario with a high-fidelity mannequin representing an elder abuse victim. After the simulation scenario, students underwent a semistructured debriefing. A tripartite approach to data collection was employed that included audio recordings of the simulation, data sheets capturing students' thoughts during the scenario, and postscenario debriefing. A different researcher analyzed each data set in isolation before discussions were held to triangulate findings from the data sets. Forty-six students undertook the scenario; none declined to participate. A number of barriers to students diagnosing elder abuse were identified. Students held a low index of suspicion for elder abuse and were overly optimistic regarding the etiology of the individual's injuries. Students lacked the confidence to raise concerns about possible elder abuse, believing that certainty was required before doing so. There was widespread confusion about nomenclature. These findings provide clinical teachers with important topic areas to address in future teaching sessions. Simulation, as a method to teach about elder abuse in a reproducible and immersive fashion, is recommended to clinical teachers.

Agreement between ambulance and hospital records for information promoting urgent stroke treatment decisions.

OBJECTIVE: Rapid decision-making during acute stroke care can improve outcomes. We wished to assess whether crucial information to facilitate decisions is routinely collected by emergency practitioners before hospital admission. MATERIALS AND METHODS: We examined whether ambulance records contained information relevant to a thrombolysis treatment decision for consecutive stroke admissions to three emergency departments in England between 14 May 2012 and 10 June 2013. RESULTS: In all, 424 of 544 (78%) records included a paramedic diagnosis of stroke. Twice as many hospital records contained a symptom onset time/last known to be well time, but there was 82% agreement within 1 h when a prehospital time was also recorded. This was more likely for younger patients. Documentation of medication history was infrequent (12%), particularly for anticoagulant status (6%). When compared with hospital documentation, paramedics recorded a history of diabetes for 38/49 (78%), previous stroke 44/69 (64%), hypertension 71/140 (51%) and atrial fibrillation 19/64 (30%). CONCLUSION: In a retrospective cohort of stroke patients admitted by emergency ambulance, standard practice did not consistently result in prehospital documentation of information that could promote rapid treatment decisions. Training emergency practitioners and/or providing clinical protocols could facilitate early stroke treatment decisions, but prehospital information availability is likely to be a limiting factor.

Stroke and TIA assessment training: a new simulation-based approach to teaching acute stroke assessment.

INTRODUCTION: Patient simulators provide an opportunity for teams to rehearse scenarios where a rapid coordinated response is essential for improving the clinical outcome. Treatment of acute ischemic stroke is time dependent and intravenous thrombolysis must be administered within hours of symptom onset. This requires a complicated assessment process often led in its initial stages by emergency department staff. We describe a new single-day training event that uses simulated scenarios to demonstrate stroke recognition and an intravenous thrombolysis protocol. METHODS: Stroke and TIA Assessment Training (STAT) uses video and audio clips from real patients in conjunction with a patient simulator to create interactive scenarios for emergency department staff. RESULTS: Between May 2009 and April 2011, 779 clinical staff in the United Kingdom attended a STAT course. Data from the first year of STAT showed that learner self-confidence for stroke assessment increased significantly. The use of the simulator was highly valued. CONCLUSIONS: A patient simulator can be successfully combined with patient video material to demonstrate neurologic features in the context of acute stroke assessment.