Anchoring Errors in Emergency Medicine Residents and Faculties.

Background: Clinical reasoning is the basis of all clinical activities in the health team, and diagnostic reasoning is perhaps the most critical of a physician's skills. Despite many advances, medical errors have not been reduced. Studies have shown that most diagnostic errors made in emergency rooms are cognitive errors, and anchoring error was identified as the most common cognitive error in clinical settings. This research intends to determine the frequency and compare the percentage of anchoring bias perceived among faculty members versus residents in the emergency medicine department. Methods: In this quasi-experimental study, Emergency Medicine's Faculties and Residents are evaluated in clinical reasoning by nine written clinical cases. The clinical data for each clinical case was presented to the participants over three pages, based on receiving clinical and para-clinical information in real situations. At the end of each page, participants were asked to write up diagnoses. Data were analyzed using one-way ANOVA test. The SPSS software (Version 16.0) was employed to conduct statistical tests, and a P value < 0.05 was considered to be statistically significant. Results: Seventy-seven participants of the residency program in the Emergency Medical group volunteered to participate in this study. Data showed Faculties were significantly higher in writing correct diagnoses than residents (66% vs. 41%), but the anchoring error ratio was significantly lower in residents (33% vs. 75%). In addition, the number of written diagnoses, time for writing diagnoses, and Clinical experience in faculties and residents were compared. Conclusion: Findings showed that increasing clinical experience increased diagnostic accuracy and changed cognitive medical errors. Faculties were higher than residents in anchoring error ratio. This error could be the result of more exposure and more decision-making in the mode of heuristic or intuitive thinking in faculties.

Neonatal Intensive Care Nursing Curriculum Challenges based on Context, Input, Process, and Product Evaluation Model: A Qualitative Study.

BACKGROUND: Weakness of curriculum development in nursing education results in lack of professional skills in graduates. This study was done on master's students in nursing to evaluate challenges of neonatal intensive care nursing curriculum based on context, input, process, and product (CIPP) evaluation model. MATERIALS AND METHODS: This study was conducted with qualitative approach, which was completed according to the CIPP evaluation model. The study was conducted from May 2014 to April 2015. The research community included neonatal intensive care nursing master's students, the graduates, faculty members, neonatologists, nurses working in neonatal intensive care unit (NICU), and mothers of infants who were hospitalized in such wards. Purposeful sampling was applied. RESULTS: The data analysis showed that there were two main categories: "inappropriate infrastructure" and "unknown duties," which influenced the context formation of NICU master's curriculum. The input was formed by five categories, including "biomedical approach," "incomprehensive curriculum," "lack of professional NICU nursing mentors," "inappropriate admission process of NICU students," and "lack of NICU skill labs." Three categories were extracted in the process, including "more emphasize on theoretical education," "the overlap of credits with each other and the inconsistency among the mentors," and "ineffective assessment." Finally, five categories were extracted in the product, including "preferring routine work instead of professional job," "tendency to leave the job," "clinical incompetency of graduates," "the conflict between graduates and nursing staff expectations," and "dissatisfaction of graduates." CONCLUSIONS: Some changes are needed in NICU master's curriculum by considering the nursing experts' comments and evaluating the consequences of such program by them.

Effectiveness of resident as teacher curriculum in preparing emergency medicine residents for their teaching role.

INTRODUCTION: Over the past 30 years, recognizing the need and importance of training residents in teaching skills has resulted in several resident-as-teacher programs. The purpose of this study was to explore the impact of this teaching initiative and investigate the improvement in residents' teaching skills through evaluating their satisfaction and perceived effectiveness as well as assessing medical students' perception of the residents' teaching quality. METHODS: This research is a quasi-experimental study with pre- and post-tests, continuing from Dec 2010 to May 2011 in Imam Hospital, Tehran University of Medical Sciences. In this survey, Emergency Medicine Residents (n=32) participated in an 8-hour workshop. The program evaluation was performed based on Kirkpatrick's model by evaluation of residents in two aspects: self-assessment and evaluation by interns who were trained by these residents. Content validity of the questionnaires was judged by experts and reliability was carried out by test re-test. The questionnaires were completed before and after the intervention. Paired sample t-test was applied to analyze the effect of RAT curriculum and workshop on the improvement of residents' teaching skills based on their self-evaluation and Mann-Whitney U test was used to identify significant differences between the two evaluator groups before and after the workshop. RESULTS: The results indicated that residents' attitude towards their teaching ability was improved significantly after participating in the workshop (p<0.001). The result of residents' evaluation by interns showed no significant difference before and after the workshop (p=0.07). CONCLUSION: On the whole, the educational workshop for Residents as Teacher for emergency medicine residents resulted in favorable outcomes in the second evaluated level of Kirkpatrick's model, i.e. it showed measurable positive changes in the self-assessments of medical residents about different aspects of teaching ability and performance. However, implementing training sessions for resident physicians, although effective in improving their confidence and self-assessment of their teaching skills, seems to cause no positive change in the third evaluated level of Kirkpatrick's model, i.e. the residents' behaviors, and it does not seem to raise students' satisfaction or meet their expectations.

Caring for people at the end of life: Iranian oncology nurses' experiences.

AIM: To explore the meaning of Iranian oncology nurses' experiences of caring for people at the end of life. MATERIALS AND METHODS: A phenomenological hermeneutic approach was applied. Fifteen nurses working in oncology units were interviewed in 2007 regarding their experiences of caring for people at the end of life. RESULTS: Participants experienced caring for people at the end of life as sharing space and time to be lost within an organizational context. This main theme was divided into three subthemes including being attentive to the dying persons and their families, being cared for by the dying persons and their families, and being faced with barriers. CONCLUSION: The study suggests that the nurses' success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.

Attitudes of Iranian nurses toward caring for dying patients.

OBJECTIVE: To examine the attitudes of Iranian nurses toward caring for dying patients. METHODS: Nurses' attitudes toward death and caring for dying patients were examined by using two types of questionnaires: the Death Attitude Profile-Revised (DAP-R) and Frommelt's Attitude towards Caring for Dying Patients (FATCOD), both with a demographic survey. RESULTS: The results showed that most respondents are likely to view death as a natural part of life and also as a gateway to the afterlife. The majority reported that they are likely to provide care and emotional support for the people who are dying and their families, but they were unlikely to talk with them or even educate them about death. They had a tendency not to accept patients and their families as the authoritative decision makers or involve families in patient care. Nurses' personal views on death, as well as personal experiences, affected their attitudes toward care of the dying. SIGNIFICANCE OF RESULTS: Lack of education and experience, as well as cultural and professional limitations, may have contributed to the negative attitude toward some aspects of the care for people who are dying among the nurses surveyed. Creating a reflective narrative environment in which nurses can express their own feelings about death and dying seems to be a potentially effective approach to identify the factors influencing their interaction with the dying. Continuing education may be required for Iranian palliative care nurses in order to improve the patients quality of care at the end of life.