Group items tagged

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"They review some classics including: "The rational clinical examination. Is this patient having a myocardial infarction?" in JAMA 1998. "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease" in JAMA 2000. "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis" in NEJM 2003. "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma" in NEJM 2003. "Computed tomography of the head before lumbar puncture in adults with suspected meningitis" in NEJM 2001."

"In conclusion, a relatively small percentage of students use multimedia (audio and video) that are provided as a duplication of lectures in the basic sciences. The distribution of frequency of access of both video and audio files was consistent across the various courses offered in the first two years of medical school. There were significant correlations in the frequencies with which individual students viewed videos of lectures from course-to-course. Finally, there was a trend for an inverse association between the frequencies with which students viewed lectures and the grades they received in the course. This is an important observation that requires further investigation since it may be indicative of a maladaptive learning strategy for some students. It also does not exclude the possibility that additional computer-aided resources may be detrimental to some students. "

ePBLMs are actual patient cases in CD format that permits free inquiry. The learner can ask any question of the patient in any sequence and get the patient's response and perform any item of the physical examination in any sequence and learn the result as in the real clinical situation. Any laboratory and diagnostic test can be ordered in any sequence as well. Whatever can be done with the actual patient on history and physical and the ordering of laboratory tests can be done with the ePBLM. A separate "User's Guide" provided with each ePBLM can be used with any of the ePBLMs in the series and provides the key for free inquiry.

"Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de-biasing to improve clinical decision making in the ED."

A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.

The Expert Skills Program (ESP) at Texas Tech was implemented in March, 2012, as a free access professional skill development opportunity for all interested students regardless of their institution. The ESP is named to reflect the broad goal of acquiring expert skills in areas ranging from clinical reasoning, patient examination, and communication to the fine motor skills employed in clinical procedures. We have been able to initiate skill development prior to formal clinical training by matching the steps used in clinical skills to the steps involved in higher order thinking skills.

"Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients. "

"This study's findings indicate that rural physicians are routinely confronted with professional boundary issues in everyday situations, and these circumstances do not always reflect those of their urban colleagues. Given the increase in longitudinal immersion clinical clerkship programs to nurture student interest in future rural practice, acknowledgment and acceptance of the nuances of dual relationships and boundary setting in different clinical learning contexts are vital to help students identify their personal needs for privacy and be better prepared to negotiate the realities of rural practice. These findings may inform future medical education initiatives on professional boundary setting as an aspect of professionalism."

The behavioral sciences are taught in medical curricula around the world. In the current paper psychologists teaching in medical schools in Australia, Mexico, Saudi Arabia, Thailand, the United Kingdom and the United States share their experience and refl

"It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context."

"Yet the presence of a computer in the examination room and the pressure to document the visit in the EHR are often perceived as adversely affecting the patient-physician interaction. How can the EHR instead have a positive effect on this interaction and promote patient activation during the course of the outpatient visit? When clinicians invite patients to view the computer screen and parts of their electronic chart, it not only avoids uncomfortable periods of idle silence that sometimes accompany EHR-related tasks, but it may enhance the relational aspect of patient-physician communication in a way that fosters patient activation in real time."

"This book is the first of its kind to guide final-year medical undergraduates in performing self-assessment in examination-style modified essay questions. It will also be useful for junior residents to evaluate their own knowledge and approaches in internal medicine, as well as senior doctors in providing inspiration and ideas for setting examination questions."

"You need to learn how to exercise mindful deployment of your attention online if you are going to become a critical consumer of digital media; productive use of Twitter or YouTube requires knowledge of who your public is, how your participation meets their needs (and what you get in return), and how memes flow through networked publics. Ultimately, the most important fluency is not in mastering a particular literacy but in being able to put all five of these literacies together into a way of being in digital culture."

"One of the most innovative educational resources in the field, Radiology 2.0 presents teaching files in a way not previously seen; the 2.0 denotes the next generation in interactive radiology education."

"The duty of the teacher in this model is not to judge and rate but, rather, to read and tell what is seen. Our teachers, having been trained in the acts of close reading, are equipped not with rating rubrics but, rather, with a reading guide that prompts the reader to attend to several narrative features of a text. The reader/coach can thereby first see and then show the writer what is contained in the written text, at least from that reader's vantage point, helping along the process not only of the writing but also of the reflection the writing birthed. Multiple readers swell and complicate the lessons learned. As a dividend, we have observed, the group of readers/writers form strong, trusting, collaborative teams. And so our training for reflection also fulfills other difficult missions of medical education in teamwork, peer learning, trust, and care."

Key benefits of the NAS include the creation of a national framework for assessment that includes comparison data, reduction in the burden associated with the current process-based accreditation system, the opportunity for residents to learn in innovative programs, and enhanced resident education in quality, patient safety, and the new competencies. Over time, we envision that the NAS will allow the ACGME to create an accreditation system that focuses less on the identification of problems and more on the success of programs and institutions in addressing them.

"Here are some of the reasons why students should be taking notes for themselves. The practice of note-taking develops several important skills-starting with listening. You can't take notes if you aren't listening. You need to be able to take decent notes because in most professional contexts, indeed in life, you are regularly in situations that require taking in and processing information that you need to remember and later apply. You can't always be asking people to give you a copy of what they just told you."