Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test.

BACKGROUND: The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined. METHODS: The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0-4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills. RESULTS: Despite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08-2.59; students: 2.34, 95% CI 2.07-2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value. CONCLUSIONS: In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.

Simulation-based mastery learning in medical students: Skill retention at 1-year follow up.

Context: Deficits in basic skill performance and long-term skill retention among medical students and novice doctors are a persistent problem. This controlled study tested whether the addition of a mastery learning component to simulation-based teaching is associated with long-term retention and performance of peripheral venous catheter insertion. Methods: Fourth-year medical students were assigned to receive either the control (simulation without mastery learning, n = 131) or the intervention (simulation + mastery learning, n = 133) instruction in peripheral venous catheter insertion. Performance was assessed at one year post-instruction. Eighty-four students from the control group and 71 from the intervention group participated in the assessment. Results: Students who received the mastery learning instruction achieved higher overall test scores than did controls (median mastery learning score: 20.0, IQR 2.0; median control score 19.0, IQR 3.0; Mann-Whitney U test, p < 0.001, effect size d = 0.82). Pass rates also differed significantly between the groups, with 74.5% (n = 53) of the intervention group passing compared with 33% (n = 28) of the control group (p < 0.001). Conclusions: Mastery learning is an effective means of teaching practical skills to medical students, and is associated with higher scores at a 1-year follow up.

Mastery learning improves students skills in inserting intravenous access: a pre-post-study.

OBJECTIVE: Inserting peripheral venous catheters (PVCs) has been identified as a core competency for medical students. Because the performance - even of hygienic standards - of both students and novice physicians is frequently inadequate, medical faculties must focus on competence-based learning objectives and deliberate practice, features that are combined in mastery learning. Our aim was to determine the competency of students in inserting PVCs before and after an educational intervention. DESIGN: This study comprised a skills assessment with pre- and post-tests of a group of third-year students who received a simulation-based intervention. A newly established curriculum involved one hour of practice at inserting PVCs on simulators. Students were required to pass a test (total 21 points, pass mark 20 points) developed on the concept of mastery learning. An unannounced follow-up test was performed one week (8 days) after the intervention. SETTING: The simulation center of the medical faculty in Muenster. PARTICIPANTS: Third-year students who received the intervention. RESULTS: One hundred and nine complete data sets were obtained from 133 students (82.5%). Most students (97.2%) passed the test after the intervention (mean score increase from 15.56 to 20.50, P<0.001). There was a significant decrease in students' performance after one week (8 days): only 74.5% of participants passed this retest (mean score reduction from 20.50 to 20.06, P<0.001). CONCLUSION: Mastery learning is an effective form of teaching practical skills to medical students, allowing a thorough preparation for the challenges of daily clinical practice.

Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation.

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients.

Practicing evidence based medicine at the bedside: a randomized controlled pilot study in undergraduate medical students assessing the practicality of tablets, smartphones, and computers in clinical life.

BACKGROUND: Practicing evidence-based medicine is an important aspect of providing good medical care. Accessing external information through literature searches on computer-based systems can effectively achieve integration in clinical care. We conducted a pilot study using smartphones, tablets, and stationary computers as search devices at the bedside. The objective was to determine possible differences between the various devices and assess students' internet use habits. METHODS: In a randomized controlled pilot study, 120 students were divided in three groups. One control group solved clinical problems on a computer and two intervention groups used mobile devices at the bedside. In a questionnaire, students were asked to report their internet use habits as well as their satisfaction with their respective search tool using a 5-point Likert scale. RESULTS: Of 120 surveys, 94 (78.3%) complete data sets were analyzed. The mobility of the tablet (3.90) and the smartphone (4.39) was seen as a significant advantage over the computer (2.38, p < .001). However, for performing an effective literature search at the bedside, the computer (3.22) was rated superior to both tablet computers (2.13) and smartphones (1.68). No significant differences were detected between tablets and smartphones except satisfaction with screen size (tablet 4.10, smartphone 2.00, p < .001). CONCLUSIONS: Using a mobile device at the bedside to perform an extensive search is not suitable for students who prefer using computers. However, mobility is regarded as a substantial advantage, and therefore future applications might facilitate quick and simple searches at the bedside.

Medical honey and its role in paediatric patients.

BACKGROUND: The use of complementary medical treatment in wound management has continued to grow throughout the world. There is a large body of evidence that supports the use of honey as a wound dressing for a wide range of wound types. The authors present an update of present knowledge about honey as a form of complementary medicine in paediatric wound management. METHODS: The literature cited was found by searching the PubMed, BIOSIS and ISI Web of Science databases for the phrase 'honey and wound'. Papers where honey was used in a mixture with other therapeutic substances were excluded. Randomised controlled trials as well as case studies were taken into consideration. RESULTS: This paper reviews data on the effectiveness of honey in wound healing; 80 citations or references were found that matched the criteria. Furthermore, the wound-healing properties of honey are described and the mechanism of action discussed. The authors' data show that honey induced enhanced epithelialisation, minimised scar formations and had an anti-microbiotic effect. CONCLUSION: These results should encourage the use of medical honey in the field of paediatrics. It is a safe and natural substance that induces wound healing at a greater rate than conventional methods.

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years.

BACKGROUND: Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students. METHODS: We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academic years. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance (IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems. RESULTS: We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity tolerance on all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medical students. CONCLUSIONS: The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did.

Using tree diagrams without numerical values in addition to relative numbers improves students' numeracy skills: a randomized study in medical education.

BACKGROUND: Physicians and medical students may lack sufficient numeracy skills to make treatment decisions, interpret test results, and practice evidence-based medicine. We evaluated whether the use of a tree diagram without numerical values as an aid for numerical processing might improve students' test results when dealing with percentages. METHODS: A prospective randomized study was carried out with 102 third-year students. Participants received 3 diagnostic test problems and were asked to determine positive predictive values. The information in these tests was expressed either in (1) natural frequencies, (2) conditional probabilities, or (3) conditional probabilities with a tree diagram without numbers. RESULTS: Ninety-eight (96.1%) complete data sets could be obtained. The group working with natural frequencies achieved significantly higher test results (n = 29, mean score: 1.1, P = 0.045) than the group working with conditional probabilities (n = 34, mean score: 0.56). The students who were given a tree diagram in addition to conditional probabilities (n = 35, mean score: 1.26) also achieved significantly better scores than the group with conditional probabilities alone (P = 0.008). The difference between the group who had received natural frequencies and the group working with conditional probabilities and the tree diagram was not significant. CONCLUSIONS: We suggest the use of a tree diagram as a visual aid when dealing with diagnostic tests expressed in conditional probabilities.

The role of complementary medicine in a pediatric day center in Germany.

BACKGROUND: The role of complementary alternative medicine (CAM) in pediatrics has considerably increased in the last years. The knowledge about potential side effects and possible interactions with conventional drugs is still limited, and often pediatricians do not know whether their patients use CAM. This can be critical, as in order to diagnose and treat illnesses properly physicians need to know about the full extent of the self-administered therapy of their patients. Many studies have been conducted in other countries in order to assess the extent of CAM use and the types of substances that are consumed, but in Germany data in regard to pediatric interventions are lacking. We therefore developed a questionnaire to evaluate the frequency of CAM use among German pediatric patients. PATIENTS AND METHODS: 115 parents visiting the pediatric day center in Epe between September and November 2011 responded to the questionnaire. The survey contains questions concerning the prevalence of CAM use and data about socioeconomic factors. RESULTS: A total of 75.7% of all children enrolled in the study had already been treated with CAM by their parents, while only 43.6% of the parents knew that there can be interactions with CAM and prescribed drugs. In only half of the cases (50.6%) the pediatrician knew about the CAM usage of the child. CONCLUSION: The frequency of CAM usage among children is higher than anticipated. It is essential that pediatricians know about possible interactions with conventional medicine, and it lies in their responsibility to include the question about CAM usage in their standard protocols.

Topical timolol for small infantile hemangioma: a new therapy option.

The main characteristic of infantile hemangioma is that it grows rapidly after birth and mostly regresses spontaneously. It is a common practice for only a small part of the hemangioma to be treated, as they can be extremely disfiguring and destructive to normal tissue as well as possibly being life-threatening. Recent studies have discovered that the use of topical 0.5% timolol maleate gel is a new therapy option for infantile hemangioma. We have treated two children with hemangioma in our pediatric day center with topical timolol gel (Nyogel). We examined the children before the therapy and took photographs of the hemangioma. After a period of two weeks, pictures were re-taken and compared. A significant change in color from dark red to a lighter shade of red and partially even to skin color could be detected. The treatment outcome of our cases indicates that timolol gel is well-tolerated and effective for the therapy for infantile hemangioma. We further want to highlight the necessity to treat even small hemangiomas, as a reliable prediction of the possible extent of the expansion and involution does not exist.

Progressive hearing loss after completion of cisplatin chemotherapy is common and more pronounced in children without spontaneous otoacoustic emissions before chemotherapy.

OBJECTIVE: High frequency hearing loss following cisplatin chemotherapy is frequent in children and often necessitates the fitting of hearing aids. During therapy, hearing is usually monitored. Post-therapeutic follow-up does not routinely include monitoring of hearing, although there are indications that hearing thresholds can decline after therapy. METHODS: Pure-tone audiograms taken from 27 children (17 males, 10 females) treated with cisplatin at Muenster university hospital (mean age 9.84 years, standard deviation 3.67 years) including an audiological follow-up at least 6 months after therapy, were analyzed retrospectively. RESULTS: In follow-up tests after completion of therapy, 24.1% of all ears showed an increase in mean high frequency hearing thresholds (4-8 kHz). Post-therapeutic hearing deterioration was significant at 4 kHz and significantly more pronounced in children without measurable spontaneous otoacoustic emissions (SOAE) before therapy. Post-therapeutic hearing deterioration did not occur in ears with normal pure tone thresholds (≤ 10dB at all frequencies) after cisplatin therapy. No correlation was found between post-therapeutic hearing deterioration and cranial irradiation. CONCLUSIONS: Cisplatin chemotherapy follow-up should include audiological monitoring in all children with elevated pure tone thresholds after therapy. Routine SOAE measurements taken as part of baseline audiometry before the start of chemotherapy can be taken into consideration.

Parent satisfaction with a pediatric practice in Germany: a questionnaire-based study.

BACKGROUND: Parental satisfaction with a pediatric day center is essential for the medical treatment of children, since it is closely related to compliance. In order to ascertain factors which predict parental satisfaction as well as to discover possible weak points, we developed a questionnaire. METHODS: 127 parents visiting the pediatric day center from October to November 2010 were asked to respond to a questionnaire. The survey was given to them directly by the doctor after their visit and it provided the opportunity to determine subjective and soft factors in quality management, which is essential for a pediatric practice. The questionnaire consisted of 27 items divided into three scales. The scales were as follows: satisfaction concerning the infrastructure and organization, satisfaction concerning the communicative and empathic competence of the doctor as well as the other staff, and finally the results and the overall impression. Moreover, the survey asked the respondents for their comments on the pediatric day center and sociodemographic data were queried. RESULTS: A total of 67 parents (52,7%) responded to the survey. The mean parental satisfaction concerning infrastructure and organization achieved 3,61 (scale 1-very unsatisfied--through 4-very satisfied). The mean satisfaction with the expertise of the doctor and the staff was 3,56 and the overall satisfaction was 3,65. Ninety-one percent of the parents would visit the pediatric practice again and 84,2% would definitely recommend the practice to others. CONCLUSION: Surveys on parental satisfaction are essential for the success of a pediatric day center. Apart from the doctors abilities to interact with the parents, other factors, such as a short waiting period, a friendly and helpful staff, as well as appealing premises are essential for a high overall level of satisfaction.