Assessing the Impact of Standardized Patient Encounters on Students' Medical History-taking Skills in Practice.

Objective. To investigate whether exposing students to professional standardized patients (SPs) in a didactic course would impact the transferability of students' medical history-taking skills to practice.Methods. In 2018, peer role-play and virtual simulation activities were used to teach medical history-taking in a first-year physical assessment and medication administration course. An unannounced SP evaluated students' medical history-taking skills during a subsequent community introductory pharmacy practice experience (IPPE) using a 17-item medical history checklist. In 2019, 3 SP encounters were added to the course to supplement existing learning activities. This student cohort was then assessed by the same unannounced SP during their IPPE in summer 2019. Medical history-taking performance was compared with the 2018 control group to assess the impact of the changes to the course.Results. Thirty-nine students in both the summer 2018 and 2019 cohorts had usable data. There was a statistically significant increase in the 2019 mean composite score on the medical history checklist (24.3 vs 18.1). The 2019 cohort performed significantly better than the 2018 cohort in 7 of the 17 items on the checklist. The correlation between students' performance on the summative medical history-taking assessment during the course and their performance in practice was r=.15 in 2018 and r=.08 in 2019.Conclusion. Incorporating SPs into a physical assessment and medication administration course contributed to an improvement in students' ability to take a medical history in practice as compared with solely using a virtual patient simulation program.

Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy.

OBJECTIVE: To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees. METHODS: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20). MAIN OUTCOMES/MEASURES: Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression. RESULTS: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p<0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3). CONCLUSIONS/RELEVANCE: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.

Students' educational experiences and interaction with residents on night shifts.

BACKGROUND: The purpose of this mixed-methods study was to investigate whether increased night shifts for students on paediatric rotations had any negative impact on their overall quality of educational experiences in light of the implementation of duty-hour restrictions. METHODS: Both quantitative and qualitative data were collected from 30 students on paediatric rotations during the academic year 2011/12. Students completed two questionnaires, one in response to their experiences during the day shifts and another in response to their experiences during the night shifts. Only 25 cases were retained for the final analyses. The non-parametric Wilcoxon signed-rank test was used to analyse the quantitative data, and constant comparative thematic analyses, as described by Creswell, were used to analyse the qualitative data. [Do] increased nights shifts for students … [have] any negative impact on their overall quality of educational experiences[?] RESULTS: The results indicated that students' perceived quality of experiences during the night shifts was greater, compared with their day shifts. Students reported having more time to socialise during the night shifts. They further reported that informal ways of learning, such as impromptu teaching and spontaneous discussions on clinical problems, were more beneficial, and these often occurred in abundance during the night shifts as opposed to the scheduled didactic teaching sessions that occur during the day shifts. DISCUSSION: This study documented many unanticipated benefits of night shifts. The feeling of cohesiveness of the night team deserves further exploration, as this can be linked to better performance outcomes. More consideration should be given to implementing night shifts as a regular feature of clerkships.