Johnsonburch6945

Purpose Educational handover (i.e., providing information about learners' past performance) is controversial. Proponents argue handover could help tailor learning opportunities. Opponents fear it could bias subsequent assessments and lead to self-fulfilling prophecies. This study examined whether raters provided with reports describing learners' minor weaknesses would generate different assessment scores or narrative comments than those who did not receive such reports. Method In this 2018 mixed-methods, randomized, controlled, experimental study, clinical supervisors from five postgraduate (residency) programs were randomized into three groups receiving no educational handover (control), educational handover describing weaknesses in medical expertise, and educational handover describing weaknesses in communication. All participants watched the same videos of two simulated resident-patient encounters and assessed performance using a shortened mini-clinical evaluation exercise form. see more The authors compared mean sack without influencing scores. Further studies are required to examine the influence of reports for a variety of performance levels, areas of weakness, and learners.Purpose Despite the importance of training in ambulatory care settings for residents to acquire important competencies, little is known about the organizational and environmental factors influencing the relative amount of time primary care residents train in ambulatory care during residency. The authors examined factors associated with postgraduate year 1 (PGY1) residents' ambulatory care training time in Accreditation Council for Graduate Medical Education (ACGME)-accredited primary care programs. Method U.S. accredited family medicine (FM) and internal medicine (IM) programs' 2016-2017 National Graduate Medical Education (GME) Census data from 895 programs within 550 sponsoring institutions (representing 13,077 PGY1s) were linked to the 2016 Centers for Medicare and Medicaid Services Cost Reports and 2015-2016 Area Health Resource File. Multilevel regression models examined the association of GME program characteristics, sponsoring institution characteristics, geography, and environmental factors with PGY1 in ambulatory care settings. These findings inform policies to increase resident exposure in ambulatory care, potentially improving learning, competency achievement, and primary care access.Background In response to COVID-19, American medical centers have enacted elective case restrictions, markedly affecting the training of orthopaedic residents. Residencies must develop new strategies to provide patient care while ensuring the health and continued education of trainees. We aimed to describe the evolving impact of COVID-19 on orthopaedic surgery residents. Methods We surveyed five Accreditation Council for Graduate Medical Education-accredited orthopaedic residency programs within cities highly affected by the COVID-19 pandemic about clinical and curricular changes. An online questionnaire surveyed individual resident experiences related to COVID-19. Results One hundred twenty-one resident survey responses were collected. Sixty-five percent of the respondents have cared for a COVID-19-positive patient. One in three reported being unable to obtain institutionally recommended personal protective equipment during routine clinical work. All programs have discontinued elective orthopaedic cases and restructured resident rotations. Most have shifted schedules to periods of active clinical duty followed by periods of remote work and self-isolation. Didactic education has continued via videoconferencing. Discussion COVID-19 has caused unprecedented changes to orthopaedic training; however, residents remain on the front lines of inpatient care. Exposures to COVID-19 are prevalent and residents have fallen ill. Programs currently use a variety of strategies to provide essential orthopaedic care. We recommend continued prioritization of resident safety and necessary training accommodations.This study was aimed to determine the effectiveness of the International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation approach with serial assessment and discussion with the ICF rehabilitation set. This prospective cohort study included consecutive patients admitted to the convalescent rehabilitation ward during the period between 1 August 2017 and 30 September 2018. Serial assessment and discussion with the ICF rehabilitation set every 2 weeks in each patient commenced from 1 April 2018. We analyzed the difference in the Extension Index of the ICF rehabilitation set between the periods before the assessment of the ICF rehabilitation set (prior period) and after that (post-period). The change of the Extension Index of the ICF rehabilitation set was higher in patients of the post-period group (n = 59) compared with those of the prior period group (n = 45) (mean 31.6, SD 18.5 vs. mean 17.3, SD 18.4, respectively; 95% confidence interval for the difference 7.0-21.5). Multiple regression analysis showed that serial assessment by the ICF rehabilitation set was independently associated with the improvement of the Extension Index. Multidisciplinary rehabilitation approach combined with serial assessment and discussion using the ICF rehabilitation set was associated with favorable recovery. Our study highlighted the effectiveness of ICF-based multidisciplinary rehabilitation in a clinical setting.Objective The Bacterial Meningitis Score (BMS) is recommended by pediatric academic societies to rule out the diagnosis of bacterial meningitis. The aim of this study was to evaluate the performance of the BMS to identify adults at no risk for bacterial meningitis. Methods We conducted a multicentric retrospective study including adults who consulted the emergency department (ED) for meningitis [cerebrospinal fluid (CSF) white blood cells ≥5/mm with a ratio of white blood cells/red blood cells less then 1900) during a 4-year period. The BMS variables were CSF positive Gram stain, CSF absolute neutrophil count ≥1000 cells/μL, CSF protein ≥80 mg/dL, peripheral blood absolute neutrophil count ≥10 000 cells/μL, and seizures. Bacterial meningitis was defined for patients who had a lumbar puncture with CSF pleocytosis and positive bacterial analysis of CSF. The primary endpoint was the sensitivity of the BMS to rule out bacterial meningitis in adults. The secondary outcome was to assess the rate of patients for whom antibiotics could have been avoided using the BMS and the diagnostic performance of procalcitonin in patients with a BMS ≥1.