RESUMO
Background: Reflective practice is associated with improved accuracy of medical diagnosis and superior performance in complex situations. Systematic observation of trainees' reflective capacities constitutes a basis for an effective support of reflective practice within the training paradigm. We set out to examine the reflective capacity among anesthesiology trainees in a tertiary referral hospital. Methods: We invited 61 anesthesiology trainees in Cork University Hospitals, Ireland, to participate. Each trainee was invited to respond to 2 investigator-written vignettes prepared by the investigators and suitable for evaluation using the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) and to produce and then respond to a written vignette based on their own experience. All responses were assessed by 2 independent assessors who had undergone training in the application of the REFLECT rubric, which gives quantifiable scores. Interrater reliability was assessed by weighted kappa coefficient. Association between years of training in medicine and level of reflective capacity was examined using correlation and multiple regression analyses, controlling for age. Results: Twenty-nine trainees agreed to participate, the overall REFLECT Level was 2.16 (SD 0.7), corresponding to "thoughtful action," indicating low to moderate reflective ability. Cronbach's alpha for the 5 items of the REFLECT scale was excellent (r = 0.92). Weighted kappa was very satisfactory (k = 0.81). A strong association was demonstrated between years in medicine and scores on REFLECT, controlling for age of participant (F = -2.57, Beta coefficient = -0.30). Respondents with less experience had greater mean REFLECT scores than respondents with more experience (F = 5.5, P = .02; post hoc mean difference = 0.7, P = .03 for ≤32 months vs ≥99 months). There was a significant effect for gender (t = -4.3, P = .001), with women's responses receiving greater REFLECT scores than men's responses (mean difference = 0.67, P = .001). Conclusions: Overall, participants demonstrated low to moderate reflective capacity, as assessed by the REFLECT rubric. Reflective capacity of the anesthesiology trainees appears to decrease as years of medical training progress. However, our respondents were not sampled over time to fully support this conclusion. Further research is needed on the psychometric properties of the REFLECT rubric and the generalizability of our findings.
RESUMO
Traumatic Brain Injury (TBI) is a major cause of death and disability; the leading cause of mortality and morbidity in previously healthy people aged under 40 in the United Kingdom (UK). There are currently little official Irish statistics regarding TBI or outcome measures following TBI, although it is estimated that over 2000 people per year sustain TBI in Ireland. We performed a retrospective cohort study of TBI patients who were managed in the intensive care unit (ICU) at CUH between July 2012 and December 2015. Demographic data were compiled by patients' charts reviews. Using the validated Glasgow outcome scale extended (GOS-E) outcome measure tool, we interviewed patients and/or their carers to measure functional outcomes. Descriptive statistical analyses were performed. Spearman's correlation analysis was used to assess association between different variables using IBM's Statistical Package for the Social Sciences (SPSS) 20. In the 42-month period, 102 patients were identified, mainly males (81%). 49% had severe TBI and 56% were referred from other hospitals. The mean age was 44.7 and a most of the patients were previously healthy, with 65% of patients having ASA I or II. Falls accounted for the majority of the TBI, especially amongst those aged over 50. The 30-day mortality was 25.5% and the mean length of hospital stay (LOS-H) was 33 days. 9.8% of the study population had a good recovery (GOS-E 8), while 7.8% had a GOS-E score of 3 (lower sever disability). Patients with Extra-Dural haemorrhage had better outcomes compared with those with SDH or multi-compartmental haemorrhages (p = 0.007). Older patients had a higher mortality, with the highest mortality (37.5%) among those over 50 years old (p = 0.009). TBI is associated with significant morbidity and mortality. Despite the young mean age and low ASA the mortality, morbidity and average LOS-H were significant, highlighting the health and socioeconomic burden of TBI.
