Medical Students Immersed in a Hyper-Realistic Surgical Training Environment Leads to Improved Measures of Emotional Resiliency by Both Hardiness and Emotional Intelligence Evaluation.

BACKGROUND: Burnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their potential improvement through hyper realistic immersion simulation training in military medical students. METHODS: Participants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event). RESULTS: Hardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components. CONCLUSION: This study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms.

The Effect of Hyper-Realistic Trauma Training on Emotional Intelligence in Second Year Military Medical Students.

INTRO: This project expanded upon previous exploration of emotional intelligence during the habituation for military second year medical students undergoing high-stress simulation with trauma and surgical skill training. The objective was to interpret emotional intelligence data before and after hyper-realistic immersion trauma training and to include a larger sample size than previously investigated. METHODS: Fifty increasingly intense mass casualty scenarios with simulated Emergency Department (ED) and Operating Room (OR) procedures were performed while students lived as if deployed in an Afghan village. Students rotated through a variety of roles in both the ED and the OR throughout the weeklong program. Second year medical students completed the EQ-i 2.0 Model for Emotional Intelligence on the first and last day of the intensive surgical skills week. Three different cohorts from three different graduating classes were followed with a total sample size of 96. Emotional intelligence in this model is defined as a combination of 5 domains each with three subdomains. RESULTS: A statistical analysis of the EQ data shows significant improvement in almost every subdomain of Emotional Intelligence from pre to post testing. The total EQ score was significantly higher with an average improvement of 3.95 points. All of the subdomains, except for emotional expression, empathy, and problem solving significantly improved following the intensive skills course. A 3 factor ANOVA including year and gender was also performed. R2 of the change in pre to post scores was around 90%, indicating practical significance in the score improvements. CONCLUSION AND IMPACT: Total emotional intelligence significantly improved from pre to post scores as well as each of the 5 domains and most subdomains. Scores improved an average of 4 points after only a 5-day training course. This training led to the most improvement in the self-perception and stress management categories. Medicine, especially high stress specialties like surgery and trauma, require physicians who are able to make decisions at a moment's notice and cope well with stressful situations. It is essential that individuals develop these intangible skills, which can be measured by emotional intelligence. Further research is needed to determine the long-term impacts of the increased emotional intelligence seen with hyper-realistic training. Some specific areas to investigate include physician performance and emotional wellbeing.

Student academic performance factors affecting matching into first-choice residency and competitive specialties.

BACKGROUND: Although specific specialties and residency programs have investigated student performance factors affecting matching, there is a paucity of information from medical schools. Furthermore, factors contributing to matching into first-choice residency have not been examined. This study aimed to identify academic performance factors affecting matching into first-choice residency and highly competitive specialties. METHODS: The authors conducted a study of 1726 graduates from their institution from 2010 to 2017 and assessed pre-/post-admission academic variables associated with matching into first choice and highly competitive specialties. RESULTS: 53.9% of graduates matched into their first choice. This was associated with passing COMLEX Level 2 CE (p = 0.01), PE (p = 0.02) on first attempt, and higher COMLEX Level 2 CE and USMLE 2 CK scores (p < 0.001 and 0.002; 14.1 and 3.9-point difference in mean scores respectively). Pre-clinical GPA (p = 0.002) and highest MCAT score (p = 0.02) were associated, however differences in means were < 1 point for both. Factors associated with matching into first choice included: MCAT (OR 0.95, 95% CI = (0.92, 0.98)), Level 2 CE score (OR = 1.01, 95% CI = (1.01, 1.02)) and passing Level 2 PE (OR = 3.68, 95% CI = (1.2, 11.28)). 12% of graduates matched into high- and 63% into low-competitiveness specialties. Matching into highly competitive specialties was associated with passing COMLEX Level 1 (p < 0.001), Level 2 CE (p < 0.001), USMLE Step 1 (p < 0.001) and Step 2 CK (p = 0.03) on first attempt. Mean scores of students matching into high- versus low-competitiveness specialties differed as follows: COMLEX Level 1 62.7 points, Level 2 CE 50.5 points, USMLE Step 1 13.6 points, Step 2 CK 7 points (all p < 0.001), as did pre-clinical GPA (2.4 points, p < 0.001). Level 1 score was the strongest predictor for matching into highly competitive specialties (OR = 1.04, 95% CI = (1.02, 1.05)). CONCLUSIONS: Licensing exam performance is important for matching into first-choice residency and into highly competitive specialties. Differences in exam scores were more pronounced for matching into highly competitive specialties than into first choice, with a larger difference in mean scores between students matching into specialties of high versus low competitiveness, than between students matching into their first- versus non first-choice residency. These results may help faculty prepare students and inform curriculum design to improve matching.

A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage.

BACKGROUND: Internationally, Factor IX complex (FIX complex) has been used to correct warfarin-induced coagulopathy. We present our experience with 28 patients using FIX complex. METHODS: A retrospective chart review was conducted between November 2002 and July 2006 on patients with warfarin-induced coagulopathy. We recorded the dose and timing of FIX complex, serial international normalized ratios (INRs), early adverse events, and patient outcome. RESULTS: Twenty-eight patients met criteria. The mean INR on admission was 5.1, and after FIX complex infusion was reduced significantly to 1.9 (P = .008). Eleven patients had a repeat INR drawn within 30 minutes after FIX complex infusion. The mean time to correction was 13.5 minutes. There were no early thrombotic events or allergic reactions. CONCLUSIONS: FIX complex results in an immediate reversal of coagulopathy within 15 minutes after administration. Its use should be considered as an alternative treatment to fresh-frozen plasma and recombinant Factor VIIa. Prospective randomized trials are needed to confirm these findings.