Using Didactics and Simulation to Enhance Comfort, Knowledge, and Skills of Nonsurgical Trainees Caring for Patients With Tracheostomy and Laryngectomy.

INTRODUCTION: Management of tracheostomy and laryngectomy is an important skill for physicians who often care for patients with multiple, comorbid, chronic medical conditions. There is little published literature on training for tracheostomy and laryngectomy care during nonsurgical specialty residencies. This project was designed to assess and improve comfort with, knowledge of, proficiency in tracheostomy and laryngectomy care. METHODS: This prospective observational study comprised 122 physician trainees from internal medicine, emergency medicine, and anesthesia training programs at the University of Arkansas for Medical Sciences participating in a simulation-based curriculum from April 2016 to December 2016. The curriculum included didactic session, hands-on experience performing a tracheostomy change, and practicing emergency scenarios on interactive, high-fidelity simulation mannequins. Preintervention and postintervention assessments of self-perceived comfort, objective knowledge, and tracheostomy change proficiency were performed and results compared. RESULTS: Self-perceived comfort improved from a mean Likert score from 2.12 to 4.43 (P = 0.009). Knowledge mean scores improved from 57% to 82% (P < 0.001) on multiple-choice testing. Tracheostomy change proficiency mean scores improved from 41% to 84% (P < 0.001) of proficiencies correctly performed. Six-month follow-up assessment of comfort and knowledge showed statistically significant retention of comfort (P = 0.002) and knowledge (P = 0.026). CONCLUSIONS: Comprehensive tracheostomy and laryngectomy education, which combines enhancement of knowledge with simulation of both routine and emergent aspects of care, is an effective strategy in improving confidence with, knowledge of, proficiency in tracheostomy and laryngectomy care. Retention of confidence and knowledge was demonstrated 6 months later.

The Research Environment Norm Inventory (RENI): a study of integrity in research administrative systems.

University research administrators have been generally ignored in basic studies of research integrity. Hensley noted that research administrators are "essential... to the achievement of the specific missions of postsecondary institutions... and to science and the academic infrastructure". The following study sought to extend the scope of research on research integrity to research administrative structures with a new instrument called the Research Environment Norm Inventory or RENI. University research administrators and their professional association were targeted for data collection. Evidence suggested that research administration in the United States supports integrity in the research environment through: (1) respect for community; (2) respect for institutional boundaries; (3) professionalism; (4) respect for authority structures; (5) sensitivity to system conflicts. The study suggested that integrity structures are dictated largely by the institutional settings and environments.

Virtue blindness and hegemony: qualitative evidence of negotiated ethical frameworks in the social language of university research administration.

The study used critical discourse analysis (CDA) to elucidate normative structures of ethical behavior in university research administration which may be useful for knowledge transference to future studies of research integrity. Research administration appears to support integrity in the research environment through four very strong normative domains: (1) respect for authority structures; (2) respect for institutional boundaries; (3) professionalism; and (4) a strong sense of virtue. The strong norm structure of research administration, however, appears to be threatened by the fifth domain, (5) political power, which is inhabited by prestigious faculty with tenure, top-down authority misalignment, and the power for some institutional members to circumvent the system. The strong normative structure also appears threatened by the overall consequentiality of the regulatory environment, and shifting contexts that threaten personal virtue. In the end, the normative structure is fluid, politically acquiescent to power, and ambiguous. Although the professional core of the norm structure is strong, the strengths and weaknesses in the overall system can be connected to poorly constructed elements of the institutional environment.