Association of Medical Students' Stress and Coping Skills With Simulation Performance.

INTRODUCTION: Medical students are vulnerable to experience stress, as they are routinely confronted with stressors. Acute stress can reduce students' performance on examinations, and chronic stress can contribute to cognitive disorders. Conversely, stress coping skills can reduce trainees' anxiety. Thus, stress coping skills may help students manage stress effectively and better maintain clinical performance. The goal of this study was to assess the relationship between medical students' stress, workload, stress coping skills, performance-enhancing mental skills, and clinical performance during a simulated clinical scenario. METHODS: During their surgery clerkship rotation, third-year medical students participated in a simulated scenario designed to assess their ability to care for an acutely ill surgical patient. Participants' physiological stress was assessed using heart rate (HR) monitors during the simulation, their perceived stress using the State-Trait Anxiety Inventory, and workload using the NASA-Task Load Index immediately after. Clinical performance was assessed using a global rating scale. Stress coping skills were also assessed. The relationship between performance, stress level, workload, and coping skills was examined. RESULTS: Forty-one third-year medical students voluntarily participated in the study. Participants' clinical performance was negatively correlated with perceived stress and workload during the scenario (P < 0.05). A stepwise linear regression model revealed that higher HR was the main predictor of poorer clinical performance (P < 0.05). CONCLUSIONS: In this study, medical students' HR was associated with poorer performance during a simulated clinical scenario. Adaptive stress coping skills may allow medical students to manage stressful situations and better maintain performance.

Objective Measures of Communication Behavior Predict Clinical Performance.

OBJECTIVE: Effective teamwork and communication are critical to patient outcomes, and subjective assessment tools have been studied in predicting team performances. However, inherent biases remain while using subjective assessment tools. This study hypothesizes that objective communication features can assess and predict clinical performance. DESIGN: Forty 3rd-year medical students participated in the Acute Care Trauma Simulation as the role of doctor, teaming up with a nurse confederate and a simulated patient. Participants conducted postoperative patient management, patient care diagnoses, and treatment. Audio from all team members were recorded, speech variables (e.g., speech duration, number of conversations, etc.) were extracted, and statistical analyses were performed to associate communication with clinical performance. SETTING: This study was performed at the simulation center located at Fairbanks Hall, Indiana University School of Medicine. PARTICIPANTS: Data from forty 3rd-year medical students were collected and analyzed. RESULTS: Majority (67%) of the communications were initiated by student. Speech ratio, intensity, and frequency of communications differed when students communicate with nurse than with patient (e.g., student communication to patient had higher intensity than nurse). Increasing frequency of check-backs between student and nurse (p < 0.05) and speech duration from student to patient (p = 0.001) positively associated with student's clinical performance score. CONCLUSION: Objective communication features can predict medical trainee's clinical performance and provide an objective approach for simulation-based trauma care training.

Use of non-technical skills can predict medical student performance in acute care simulated scenarios.

BACKGROUND: Though the importance of physician non-technical (NT) skills for safe patient care is recognized, NT skills of medical students, our future physicians, has received little attention. This study aims to investigate the relationship of medical student NT skills and clinical performance during acute care team simulation (ACTS). METHODS: Forty-one medical students participated in ACTS. A nurse confederate facilitated and evaluated clinical performance. Two raters assessed participants' NT skills using an adapted NT assessment tool and overall NT skills score was calculated. Regressions predicting clinical performance using NT constructs were conducted. RESULTS: Overall NT skills score significantly predicted students' clinical performance (r2 = 0.178, p = 0.006). Four of the five individual NT constructs also significantly predicted performance: communication (r2 = 0.120, p = 0.027), situation awareness (r2 = 0.323, p < 0.001), leadership (r2 = 0.133, p = 0.019), and decision making (r2 = 0.163, p = 0.009). CONCLUSIONS: Medical student NT skills can predict clinical performance during ACTS. NT skills assessments can be used for targeted education for better feedback to students.

Minimally Invasive Incision and Drainage Technique in the Treatment of Simple Subcutaneous Abscess in Adults.

A minimally invasive (MI) approach using small incisions and vessel loops for drainage of simple perianal abscesses has been described in the pediatric population with decreased postoperative pain and comparable results to the traditional incision and drainage (I&D). The hypothesis was MI I&D will yield similar outcomes in adults. Patients who underwent I&D of perianal abscesses at an urban hospital from January 2008 to December 2015 were identified by Current Procedural Terminology code. Patients below 18 years of age, with inflammatory bowel diseases, or fistulae were excluded. Recurrences, readmissions, operative time, length of stay, complications, and costs were compared. There were 47 traditional and 96 MI I&D with no significant differences in demographics, average body mass index, and abscess size. No significant differences were noted in recurrences, readmissions, length of stay, operative time, or costs (P > 0.05). Postoperative complications occurred more frequently in the traditional group (P < 0.01) with a lower rate of follow-up (P < 0.05). MI I&D for simple anal abscesses in adults is associated with better compliance and fewer complications than the traditional approach. Although further studies are needed to determine if MI I&D confers superiority, this approach should be considered as first-line treatment for uncomplicated perirectal abscesses in adults.

Use of Highly Specific Molecular Markers Reveals Positive Correlation between Abundances of Mesodinium cf. major and Its Preferred Prey, Teleaulax amphioxeia, During Red Water Blooms in the Columbia River Estuary.

In a previous study, Teleaulax amphioxeia-the preferred prey of Mesodinium in the Columbia River estuary-were undetectable within intense annual blooms, suggesting blooms are prey-limited or prey are acquired outside of bloom patches. We used a novel molecular approach specifically targeting the prey (i.e., Unique Sequence Element [USE] within the ribosomal RNA 28S D2 regions of T. amphioxeia nucleus and nucleomorph) in estuarine water samples acquired autonomously with an Environmental Sample Processor integrated within a monitoring network (ESP-SATURN). This new approach allowed for both more specific detection of the prey and better constraint of sample variability. A positive correlation was observed between abundances of M. cf. major and T. amphioxeia during bloom periods. The correlation was stronger at depth (> 8.2 m) and weak or nonexistent in the surface, suggesting that predator-prey dynamics become uncoupled when stratification is strong. We confirmed exclusive selectivity for T. amphioxeia by M. cf. major and observed the incorporation of the prey nucleus into a 4-nuclei complex, where it remained functionally active. The specific biomarker for T. amphioxeia was also recovered in M. cf. major samples from a Namibian coastal bloom, suggesting that a specific predator-prey relationship might be widespread between M. cf. major and T. amphioxeia.

Delivery of nanoparticles to brain metastases of breast cancer using a cellular Trojan horse.

As systemic cancer therapies improve and are able to control metastatic disease outside the central nervous system, the brain is increasingly the first site of relapse. The blood-brain barrier (BBB) represents a major challenge to the delivery of therapeutics to the brain. Macrophages originating from circulating monocytes are able to infiltrate brain metastases while the BBB is intact. Here, we show that this ability can be exploited to deliver both diagnostic and therapeutic nanoparticles specifically to experimental brain metastases of breast cancer.

A cellular Trojan Horse for delivery of therapeutic nanoparticles into tumors.

Destruction of hypoxic regions within tumors, virtually inaccessible to cancer therapies, may well prevent malignant progression. The tumor's recruitment of monocytes into these regions may be exploited for nanoparticle-based delivery. Monocytes containing therapeutic nanoparticles could serve as "Trojan Horses" for nanoparticle transport into these tumor regions. Here we report the demonstration of several key steps toward this therapeutic strategy: phagocytosis of Au nanoshells, and photoinduced cell death of monocytes/macrophages as isolates and within tumor spheroids.