Medical students in the pre-hospital environment - An untapped resource for undergraduate acute care and interprofessional education.

BACKGROUND: The King's College London Pre-hospital Care Programme (KCL PCP) is a student-run programme that provides undergraduate medical students with the opportunity to attend observer shifts with the local ambulance service. This study evaluates the contribution of pre-hospital exposure to medical students' clinical and professional development. METHODS: Students were asked to complete a Likert-scale based survey on self-reported exposure and confidence in various aspects of acute patient assessment, communication and interprofessional education, both before and after the programme; additional qualitative questions querying their experience were asked post-programme. Pre and post-programme Likert-scale responses were matched and statistically analysed, alongside a thematic analysis of qualitative responses. RESULTS: Exposure to ambulance service clinicians, confidence assessing acutely unwell patients, and confidence making clinical handovers all increased with statistical significance. Key areas of learning identified from the thematic analysis include increased confidence communicating with patients and families, and an enriched understanding of the work done by pre-hospital clinicians. CONCLUSIONS: Time spent in the pre-hospital environment shadowing ambulance service clinicians positively contributes to acute care knowledge, inter-personal skills and interprofessional understanding. Rotating medical students through the pre-hospital environment could bridge education gaps in these areas in a manner that complements traditional pre-clinical and clinical teaching.

Exploring the utility of neuro-monitoring in neurosurgery: The users' perspective in a single center.

BACKGROUND: The purpose of intraoperative neuro-monitoring (IONM) is to minimize injury to eloquent neural structures and optimize tumor resection. METHOD: We explored the utility of IONM using a qualitative approach in a single center. Eight experienced users of its use in spinal and cranial surgery in adults and children were the informants. Using a constant comparative method, the findings were collated by thematic analysis. RESULTS: The user perspective is that of caution to minimize adverse effects whilst empowering the need for formal training to enhance its efficacy. The process of IONM needs standardization as practices vary amongst users. Most users expressed limited trust on its current capabilities but hoped for its advancement to achieve higher sensitivity and specificity. None were however prepared to abandon its use. CONCLUSION: IONM needs optimization. Its utility depends on user vigilance, multi-disciplinary validation, and individual expertise. This study draws out key issues from the user perspective that need to be addressed in order to enhance the utility of IONM.