Assessing electrodiagnostic skills among residents and fellows: Relationships between workplace-based assessments using the Electromyography Direct Observation Tool and other measures of trainee performance.

INTRODUCTION/AIMS: Graduate medical education programs must ensure residents and fellows acquire skills needed for independent practice. Workplace-based observational assessments are informative but can be time- and resource-intensive. In this study we sought to gather "relations-to-other-variables" validity evidence for scores generated by the Electromyography Direct Observation Tool (EMG-DOT) to inform its use as a measure of electrodiagnostic skill acquisition. METHODS: Scores on multiple assessments were compiled by trainees during Clinical Neurophysiology and Electromyography rotations at a large US academic medical center. Relationships between workplace-based EMG-DOT scores (n = 298) and scores on a prerequisite simulated patient exercise, patient experience surveys (n = 199), end-of-rotation evaluations (n = 301), and an American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) self-assessment examination were assessed using Pearson correlations. RESULTS: Among 23 trainees, EMG-DOT scores assigned by physician raters correlated positively with end-of-rotation evaluations (r = 0.63, P = .001), but EMG-DOT scores assigned by technician raters did not (r = 0.10, P = .663). When physician and technician ratings were combined, higher EMG-DOT scores correlated with better patient experience survey scores (r = 0.42, P = .047), but not with simulated patient or AANEM self-assessment examination scores. DISCUSSION: End-of-rotation evaluations can provide valid assessments of trainee performance when completed by individuals with ample opportunities to directly observe trainees. Inclusion of observational assessments by technicians and patients provides a more comprehensive view of trainee performance. Workplace- and classroom-based assessments provide complementary information about trainee performance, reflecting underlying differences in types of skills measured.

Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study.

Background and study aims Studies have linked cecal intubation rate with adenoma detection rate; however, the direct association between technical performance during colonoscopy intubation and withdrawal has never been explored. Thus, it remains unclear whether gentle and efficient intubation predicts superior mucosal inspection. The aim of this study was to investigate the correlation between performance during intubation and withdrawal in a simulation-based setup. Methods Twenty-four physicians with various experience in colonoscopy performed twice on the Endoscopy Training System (ETS). Intubation skills were evaluated by assessing tasks on the ETS related to intubation (scope manipulation and loop management) and use of a computerized assessment tool called the 3D-Colonoscopy Progression Score (3D-CoPS). Diagnostic accuracy was defined by the number of polyps found during the ETS task of mucosal inspection. Pearson's correlations were calculated to explore associations between intubation skill and diagnostic accuracy. Results The correlation analysis between 3D-CoPS and number of polyps found during mucosal inspection revealed a weak and insignificant correlation (0.157, P  = 0.3). Likewise, an insignificant correlation was seen between ETS intubation and number of polyps found (0.149, P  = 0.32). Conclusions We found no evidence to support that technical performance during intubation is correlated with mucosal inspection performance in a simulation-based setting.

Cultural influence on generational gaps: A case for medical education in the Gulf region.

OBJECTIVE:  To explores cultural differences between generations of faculty and students in undergraduate medical education and to develop an educational framework for stakeholders involvement. METHODS:  This is a prospective cross-sectional mixed method study. A survey was administered on students and faculty members to measure generational differences using Hofstede's dimensions of cultural orientation. The study took place at King Abdulaziz University-Faculty of Medicine, Jeddah, Saudi Arabia, on February 2015. Quantitative methods, descriptive statistics, and correlations and regression analyses were used in data analysis. In addition, qualitative data from focus groups were used to explain findings obtained from the survey. RESULTS:  A total of 736 respondents were surveyed (129 faculty members and 607 medical students). Faculty members across all generations shared the same cultural values of low power distance and masculinity and high uncertainty avoidance, long-term orientation and collectivism. Advanced medical students showed higher power distance, collectivism, masculinity and long-term orientation than faculty members; junior medical students have higher masculinity and lower uncertainty avoidance and collectivism. CONCLUSION:  This study explains both the cultural gap between Saudi and Western medical students as well as between Saudi generations, demonstrating the need for customized curricular revisions.

Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy.

BACKGROUND: Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy. METHODS: In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems. RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems. CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.

Assessment of pediatric residents burnout in a tertiary academic centre.

OBJECTIVES: To study burnout among pediatric residents at King  Abdulazaiz University Hospital in Jeddah, Saudi Arabia. Methods: This is a cross-sectional survey that was administered to all pediatric residents enrolled in the Saudi Paediatric Board program (PGY1-PGY4) in a large tertiary academic hospital in the Western region of Saudi Arabia (King Abdulaziz University Hospital). The survey were sent via E-mail to 50 registered general pediatric residents.  Results: Seventy percent of the pediatric residents completed the survey. More than 70% of residents experiencing severe burnout. Forty-three percent suffering emotional exhaustion, 71.8% experiencing depersonalization and 40.6% suffering from low accomplishment. CONCLUSION: Burnout syndrome appear to be a serious threat to resident well-being in our program. Moreover, pediatric residents in our institute experienced higher levels of depersonalization than their peers nationally and internationally.

Association Between Small Decrease in Serum Sodium Concentration within the Normal Range and All-Cause and Cardiovascular Mortality in Elderly Adults over 5 Years.

OBJECTIVES: To determine the importance of a decrease in serum sodium concentration within the normal range in elderly adults. DESIGN: Prospective cohort. SETTING: The Korean Longitudinal Study on Health and Aging. PARTICIPANTS: Randomly selected, community-based elderly population with a corrected serum sodium level between 135.0 and 145.0 mEq/L (N = 949). MEASUREMENTS: Survival status was determined during 63.3 ± 16.6 months of follow-up. RESULTS: Participants were divided into corrected sodium groups as follows: 73 (7.7%) in Group 1 (sodium 135.0-138.0 mEq/L), 635 (66.9%) in Group 2 (sodium 138.1-142.0 mEq/L), and 241 (25.4%) in Group 3 (sodium 142.1.0-145.0 mEq/L). There were 34 (46.6%) deaths in Group 1, 124 (19.5%) in Group 2, and 52 (21.6%) in Group 3 (P < .001). In a Cox proportional hazards analysis, a 2-mEq/L higher sodium level reduced the risk of death by 14.9% (95% confidence interval (CI) = 0.1-27.4%, P = .048). Group 1 had risk of mortality that was 2.7 times as high as that of Group 2 (95% CI = 1.76-4.11, P < .001). Participants with a measured sodium level of 138.0 mEq/L or less and a corrected sodium level greater than 138.0 mEq/L had a better survival rate than those with a measured sodium level of 138.0 mEq/L or less and a corrected sodium level of 138.0 mEq/L or less. CONCLUSION: A slightly lower serum sodium concentration within the normal range was a major risk factor for mortality in elderly adults. Sodium level corrected according to serum glucose concentration was a more meaningful risk factor than measured sodium level.

A 5-year experience with an elective scholarly concentrations program.

PROBLEM: Programs that encourage scholarly activities beyond the core curriculum and traditional biomedical research are now commonplace among US medical schools. Few studies have generated outcome data for these programs. The goal of the present study was to address this gap. INTERVENTION: The Scholarly Concentration (SC) Program, established in 2006 at the Warren Alpert Medical School of Brown University, is a 4-year elective program that not only encourages students to pursue scholarly work that may include traditional biomedical research but also seeks to broaden students' focus to include less traditional areas. We compared characteristics and academic performance of SC students and non-SC students for the graduating classes of 2010-2014. CONTEXT: Approximately one-third of our students opt to complete an SC during their 4-year undergraduate medical education. Because this program is additional to the regular MD curriculum, we sought to investigate whether SC students sustained the academic achievement of non-SC students while at the same time producing scholarly work as part of the program. OUTCOME: Over 5 years, 35% of students elected to enter the program and approximately 81% of these students completed the program. The parameters that were similar for both SC and non-SC students were age at matriculation, admission route, proportion of undergraduate science majors, and number of undergraduate science courses. Most academic indicators, including United States Medical Licensing Examinations scores, were similar for the two groups; however, SC students achieved more honors in the six core clerkships and were more likely to be inducted into the medical school's two honor societies. Residency specialties selected by graduates in the two groups were similar. SC students published an average of 1.3 peer-reviewed manuscripts per student, higher than the 0.8 manuscripts per non-SC student (p=0.013). CONCLUSIONS: An elective, interdisciplinary scholarly program with a focus beyond traditional biomedical research offers students the opportunity to expand the scope of their medical education without an untoward effect on academic performance or residency placement.

Profile preferences of Korean American orthodontic patients and orthodontists.

AIM: The purpose of this study was to determine differences in preference for Korean American facial profiles among Korean American orthodontic patients with 2 levels of acculturation, Asian American orthodontists, and Caucasian orthodontists. METHODS: Images of 1 male and 1 female Korean American adult were animated to move parts of the faces from an extreme retrusive position to an extreme protrusive position by using the Perceptometrics computer program. Three movies were created of the nose, lips, and chin for each image. Three groups of judges, ie, 18 Korean American orthodontic patients, 17 Asian orthodontists, and 18 Caucasian orthodontists selected the most pleasing position and the zone of acceptability as a measure of tolerance. RESULTS: Statistically significant differences were found between Caucasian orthodontists and Korean American orthodontic patients for the most pleasing and midpoint of acceptability positions of female nose and male chin, with no differences in the zone of acceptability position among the groups. CONCLUSION: In general, the Korean American orthodontic patients preferred a more protrusive nose on the female image and more retrusive chin on the male image than Caucasian orthodontists for the most pleasing and midpoint of acceptability positions, with similar zone of acceptability for all 3 groups.