High-fidelity simulation training programme for final-year medical students: implications from the perceived learning outcomes.

We designed a session of high-fidelity simulation training course for final-year medical students in their emergency medicine specialty clerkship. This was a new initiative with clearly defined learning outcomes. We aimed to evaluate the learning outcomes. Students completed an evaluation form at the end of the session focusing on their perceived learning outcomes. Thematic analysis was conducted for data processing. We collected responses from 149 students. In addition to the intended outcomes of the course, students gained unexpected learning outcomes from the training and some of them matched a few identified learning gaps between undergraduate medical education and their subsequent transition to early clinical practice that have been described in the literature. High-fidelity simulation training in medical school could be an effective tool to address some of the identified gaps in the transition between undergraduate medical education and postgraduate practice.

Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Hong Kong.

Community-associated methicillin resistant Staphylococcus aureus is an emerging cause of skin and soft tissue infections in Hong Kong, especially among certain ethnic minorities.

Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department.

AIM: To evaluate the effect of triage rapid initial assessment by doctor (TRIAD) on waiting time and processing time of an emergency department (ED) without extra staff. METHOD: A senior emergency doctor was put into triage instead of a consultation cubicle for seven shifts of 9 hours each. All the patients were assessed and necessary interventions started at the time of triage. Waiting time and processing time of various categories of patients were compared with a control group that was sampled during the week before the trial period. RESULTS: In total, there were 1310 cases in the trial period and 1355 controls. Over a quarter (27%) of the patients received triage doctor interventions. The average waiting time was reduced by 38% and the average processing time by 23%. Patients without triage intervention also had a 24% shorter waiting time because of overall improvement in efficiency. Trauma patients and patients needing radiography particularly benefited from the new system. The waiting time and processing time of category 4 and 5 patients improved significantly as a result of more efficient processing of more urgent cases. CONCLUSION: The waiting time and processing time of the ED were greatly reduced by TRIAD without extra manpower.

Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation.

OBJECTIVE: To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation. METHODS: A prospective observational study in two phases. In phase one, midazolam 2-4 mg was used as induction agent and in phase two, etomidate 0.2-0.3 mg/kg was used. The haemodynamic data were recorded before and after intubation for comparison. Changes in mean systolic blood pressure were analysed with SPSS software. RESULTS: A 10% decrease in mean systolic blood pressure was observed in the midazolam group (p = 0.001) while there was no significant change in the etomidate group. Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant. CONCLUSIONS: Midazolam, even in low dose, was more likely than etomidate to cause significant hypotension when used as an induction agent for rapid sequence intubation. Etomidate is a better alternative.