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Military Medicine May 2023As gatekeepers to the medical profession, admissions committees make important decisions through the analysis of quantitative (e.g. test scores and grade point averages)...
INTRODUCTION
As gatekeepers to the medical profession, admissions committees make important decisions through the analysis of quantitative (e.g. test scores and grade point averages) and qualitative (e.g. letters of recommendation and personal statements) data. One area of the application that deserves additional study is the Work and Activities section, where students describe their extracurricular experiences. Previous research has found different themes that sometimes overlap in the applications of exceptional performing and low performing medical students, but it is unclear if these themes are present in the applications of standard performers.
MATERIALS AND METHODS
An exceptional performing medical student is defined as one who was inducted into both the Alpha Omega Alpha Honor Medical Society and the Gold Humanism Honor Society. A low performing medical student is one who was referred to the Student Promotions Committee (SPC) where an administrative action was made. A standard performing medical student is defined as someone who was neither a member of an honor society nor referred to the SPC during medical school. Using a constant comparative method, the applications of standard performers who graduated from the Uniformed Services University between 2017 and 2019 was assessed using exceptional performer themes (success in a practiced activity, altruism, teamwork, entrepreneurship, wisdom, passion, and perseverance) and low performer themes (witnessing teamwork, embellishment of achievement, and description of a future event). The presence of novel themes was also assessed. The absolute number of themes and the diversity of themes were determined. Demographic data were collected (age, gender, number of Medical School Admissions Test [MCAT] attempts, highest MCAT score, and cumulative undergraduate grade point average), and descriptive statistics was performed.
RESULTS
A total of 327 standard performers were identified between 2017 and 2019. No novel themes were found after coding 20 applications. All exceptional performer themes were identified in the population of standard performers. The low performing theme of embellishment of achievement was not found. Standard performers had a lower number of total exceptional performer themes and a lower diversity of exceptional performer themes compared to low and exceptional performers, but standard performers also had a lower number and less diversity of low performing themes compared to low performers.
CONCLUSIONS
This study suggests that the diversity and frequency of exceptional performing themes in a medical school application may be useful in distinguishing between exceptional performers and other performers, though the small sample size limits quantitative conclusions. Low performing themes may be specific to low performers and thus could be useful to admissions committees. Future studies should include a larger sample size and could assess for predictive validity evidence of these exceptional performing and low performing themes through a blinded protocol.
Topics: Humans; Educational Measurement; Schools, Medical; Students, Medical; Academic Success; Societies
PubMed: 37201484
DOI: 10.1093/milmed/usad073 -
Journal of Education & Teaching in... Jan 2020This curriculum was developed for emergency medicine (EM) residents at the post-graduate year (PGY) 1-4 level, and attending EM physicians. It may be adapted for...
AUDIENCE
This curriculum was developed for emergency medicine (EM) residents at the post-graduate year (PGY) 1-4 level, and attending EM physicians. It may be adapted for training of any healthcare provider or learner who might be required to perform an emergency cricothyrotomy, including emergency medical technicians, senior medical students, and advanced practice providers (ie, nurse practitioners and physician assistants); however, we did not specifically validate it for these providers.
INTRODUCTION
Emergency cricothyrotomy (EC) is a lifesaving surgical procedure, often the option of last resort, used to secure the airway when other methods of airway control have failed or are not feasible. It is a high-risk procedure since it is infrequently performed, but it is time-sensitive and critical for survival when needed.1,2 Time-sensitive procedural skills such as EC are subject to relatively rapid decay,3,4 and unlike other high-risk procedures, in which just-in-time training (JITT) may improve real time procedural performance, the extreme time sensitivity of cricothryotomy precludes JITT as a feasible educational intervention to improve EC performance.5 As such, clinicians must periodically review the essential concepts and practice the physical actions of the procedure in order to build and maintain familiarity with the steps involved and to develop and maintain the muscle memory necessary to perform it quickly and confidently. Previous studies have shown that simulation-based training improves both confidence and competence in the performance of the simulated procedures,6,7 and that small group learning situations are effective for procedural learning.8,9Commercially produced mannequins are available to simulate cricothyrotomy. However, being made of plastic materials, they suffer from unrealistic "tissue" feel that is radically different from that of biologic tissue.10,11 Additionally, because they are mass-produced, they tend to be fairly homogeneous in their anatomic representations, lacking the variability encountered in the human population.We developed an inexpensive procedure simulator using commercially available porcine byproduct that more closely mimics the feel of cricothyrotomy in real life, and a comprehensive curriculum for instruction in, or review of, EC, intended for implementation in a small-group format. This publication is intended to provide interested educators with a comprehensive suite of materials for teaching EC at their own institution. Included are instructions for how to construct the simulator, an EC case scenario with discussion points, a PowerPoint didactic module covering the fundamental concepts of EC, and sample course evaluation forms that may be implemented directly or adapted to meet institutional requirements.
EDUCATIONAL OBJECTIVES
After completing this activity, the learner will be able to:correctly describe the indications for and contraindications to emergency cricothyrotomycorrectly describe and identify on the simulator the anatomic landmarks involved in emergency cricothyrotomycorrectly list the required equipment and the sequence of the steps for the "standard" and "minimalist" variations of the proceduredemonstrate proper technique when performing a cricothyrotomy on the simulator without prompts or pauses.
EDUCATIONAL METHODS
Small group activity combining didactic learning, case-based learning, and procedural simulation. The didactic component may be delivered in an asynchronous learning or "flipped classroom" format.
RESEARCH METHODS
The cricothyrotomy simulator was initially pilot-tested on a group of emergency medicine attending faculty, who were asked to evaluate the simulator, with results demonstrating that it was felt to be superior to typical plastic mannequin simulators. This simulator was then subsequently integrated into our airway workshops teaching EC, which include hands-on practice, didactic, and discussion components. The content and delivery of these workshops were assessed by the learners via standardized evaluation forms after completion of each workshop, and the overall clinical relevance, appropriateness of content, and satisfaction with the workshop format were highly rated (mean score 4.87 on a 5-point scale, with 5 denoted as "Excellent").
DISCUSSION
The real-tissue model to simulate the procedure was well liked by course participants, and the learning environment was felt to be conducive to asking questions and discussion. Overall, the instructors and the learners felt that the workshops were effective in improving understanding of the procedure and increasing the comfort level and skill of the emergency physician learners in performing the procedure.
TOPICS
Cricothyrotomy, cricothyroidotomy, emergency airway, surgical airway, failed airway, rescue airway, can't intubate can't ventilate, small group activity, simulation.
PubMed: 37465596
DOI: 10.21980/J8JS9W -
Journal of Strength and Conditioning... Dec 2019Carvalho, L and Barroso, R. Ischemic preconditioning improves strength endurance performance. J Strength Cond Res 33(12): 3332-3337, 2019-Ischemic preconditioning (IPC)...
Carvalho, L and Barroso, R. Ischemic preconditioning improves strength endurance performance. J Strength Cond Res 33(12): 3332-3337, 2019-Ischemic preconditioning (IPC) has been used to improve performances in aerobic and anaerobic activities. However, a few studies aimed at observing the effects of IPC on resistance training. The purpose of this study is to examine the effects of IPC on the number of repetitions performed during high-load resistance training. We also aimed at investigating blood lactate concentration and muscle activation in an attempt to understand the physiological mechanisms that may be caused by IPC. Ten resistance-trained participants performed four 5-minute cycles of either IPC (250 mm Hg) or Placebo (10 mm Hg) before performing a single set to failure of knee extension exercise with 85% of 1 repetition maximum. We also assessed muscle activation during the set (EMGRMS), median power frequency (EMGMPF), and blood lactate concentration before, 3, 7, and 11 minutes after (peak value was identified and used to calculate delta to prevalues, Δlactate). Data are presented as mean, 90% confidence intervals (CIs), and were analyzed with paired t-test. The level of significance was set at p < 0.05. Participants performed on average 3.9 repetitions (90% CI = 2.4-5.4; p = 0.01), which is ∼20%, more in the IPC condition. There were no significant differences between IPC and Placebo for EMGMPF (5.0%; 90% CI = -5.2 to 15; p = 0.50), EMGRMS (4.5%; 90% CI = -8.8 to 17; p = 0.78), and Δlactate (44%; 90% CI = 11-144; p = 0.16). Our results demonstrate the effect of IPC just on the number of repetitions performed in high-load resistance exercise compared with the Placebo condition.
Topics: Adult; Cross-Over Studies; Electromyography; Exercise Test; Humans; Ischemic Preconditioning; Lactic Acid; Male; Muscle Strength; Muscle, Skeletal; Nutritional Status; Physical Endurance; Random Allocation; Resistance Training; Young Adult
PubMed: 30844989
DOI: 10.1519/JSC.0000000000002846 -
Statistical Methods in Medical Research Jan 2021We construct robust designs for nonlinear quantile regression, in the presence of both a possibly misspecified nonlinear quantile function and heteroscedasticity of an...
We construct robust designs for nonlinear quantile regression, in the presence of both a possibly misspecified nonlinear quantile function and heteroscedasticity of an unknown form. The asymptotic mean-squared error of the quantile estimate is evaluated and maximized over a neighbourhood of the fitted quantile regression model. This maximum depends on the scale function and on the design. We entertain two methods to find designs that minimize the maximum loss. The first is local - we minimize for given values of the parameters and the scale function, using a sequential approach, whereby each new design point minimizes the subsequent loss, given the current design. The second is adaptive - at each stage, the maximized loss is evaluated at quantile estimates of the parameters, and a kernel estimate of scale, and then the next design point is obtained as in the sequential method. In the context of a Michaelis-Menten response model for an estrogen/hormone study, and a variety of scale functions, we demonstrate that the adaptive approach performs as well, in large study sizes, as if the parameter values and scale function were known beforehand and the sequential method applied. When the sequential method uses an incorrectly specified scale function, the adaptive method yields an, often substantial, improvement. The performance of the adaptive designs for smaller study sizes is assessed and seen to still be very favourable, especially so since the prior information required to design sequentially is rarely available.
Topics: Research Design
PubMed: 32812499
DOI: 10.1177/0962280220948159 -
Journal of Medical Internet Research Jun 2022Improving rigor and transparency measures should lead to improvements in reproducibility across the scientific literature; however, the assessment of measures of...
BACKGROUND
Improving rigor and transparency measures should lead to improvements in reproducibility across the scientific literature; however, the assessment of measures of transparency tends to be very difficult if performed manually.
OBJECTIVE
This study addresses the enhancement of the Rigor and Transparency Index (RTI, version 2.0), which attempts to automatically assess the rigor and transparency of journals, institutions, and countries using manuscripts scored on criteria found in reproducibility guidelines (eg, Materials Design, Analysis, and Reporting checklist criteria).
METHODS
The RTI tracks 27 entity types using natural language processing techniques such as Bidirectional Long Short-term Memory Conditional Random Field-based models and regular expressions; this allowed us to assess over 2 million papers accessed through PubMed Central.
RESULTS
Between 1997 and 2020 (where data were readily available in our data set), rigor and transparency measures showed general improvement (RTI 2.29 to 4.13), suggesting that authors are taking the need for improved reporting seriously. The top-scoring journals in 2020 were the Journal of Neurochemistry (6.23), British Journal of Pharmacology (6.07), and Nature Neuroscience (5.93). We extracted the institution and country of origin from the author affiliations to expand our analysis beyond journals. Among institutions publishing >1000 papers in 2020 (in the PubMed Central open access set), Capital Medical University (4.75), Yonsei University (4.58), and University of Copenhagen (4.53) were the top performers in terms of RTI. In country-level performance, we found that Ethiopia and Norway consistently topped the RTI charts of countries with 100 or more papers per year. In addition, we tested our assumption that the RTI may serve as a reliable proxy for scientific replicability (ie, a high RTI represents papers containing sufficient information for replication efforts). Using work by the Reproducibility Project: Cancer Biology, we determined that replication papers (RTI 7.61, SD 0.78) scored significantly higher (P<.001) than the original papers (RTI 3.39, SD 1.12), which according to the project required additional information from authors to begin replication efforts.
CONCLUSIONS
These results align with our view that RTI may serve as a reliable proxy for scientific replicability. Unfortunately, RTI measures for journals, institutions, and countries fall short of the replicated paper average. If we consider the RTI of these replication studies as a target for future manuscripts, more work will be needed to ensure that the average manuscript contains sufficient information for replication attempts.
Topics: Checklist; Humans; Norway; Publishing; Reproducibility of Results; Research Design
PubMed: 35759334
DOI: 10.2196/37324 -
Cardiology Clinics May 2021In most patients, minimally invasive approaches to mitral valve surgery are technically possible. However, in practice, patient selection is critical to mitigate safety... (Review)
Review
In most patients, minimally invasive approaches to mitral valve surgery are technically possible. However, in practice, patient selection is critical to mitigate safety concerns when performing the procedure. In this article, we describe our approach to preoperative assessment for minimally invasive mitral valve surgery candidacy, as well as discussing the technical aspects of procedure execution.
Topics: Cardiac Surgical Procedures; Humans; Minimally Invasive Surgical Procedures; Mitral Valve; Patient Selection; Thoracotomy; Treatment Outcome
PubMed: 33894935
DOI: 10.1016/j.ccl.2021.01.003 -
Biometrical Journal. Biometrische... Oct 2020In observational studies, subjects are often nested within clusters. In medical studies, patients are often treated by doctors and therefore patients are regarded as...
In observational studies, subjects are often nested within clusters. In medical studies, patients are often treated by doctors and therefore patients are regarded as nested or clustered within doctors. A concern that arises with clustered data is that cluster-level characteristics (e.g., characteristics of the doctor) are associated with both treatment selection and patient outcomes, resulting in cluster-level confounding. Measuring and modeling cluster attributes can be difficult and statistical methods exist to control for all unmeasured cluster characteristics. An assumption of these methods however is that characteristics of the cluster and the effects of those characteristics on the outcome (as well as probability of treatment assignment when using covariate balancing methods) are constant over time. In this paper, we consider methods that relax this assumption and allow for estimation of treatment effects in the presence of unmeasured time-dependent cluster confounding. The methods are based on matching with the propensity score and incorporate unmeasured time-specific cluster effects by performing matching within clusters or using fixed- or random-cluster effects in the propensity score model. The methods are illustrated using data to compare the effectiveness of two total hip devices with respect to survival of the device and a simulation study is performed that compares the proposed methods. One method that was found to perform well is matching within surgeon clusters partitioned by time. Considerations in implementing the proposed methods are discussed.
Topics: Cluster Analysis; Computer Simulation; Confounding Factors, Epidemiologic; Humans; Observational Studies as Topic; Propensity Score; Research Design
PubMed: 32419247
DOI: 10.1002/bimj.201900277 -
The Journal of Continuing Education in... Sep 2023The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence,...
INTRODUCTION
The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training.
METHODS
A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed.
RESULTS
Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant.
DISCUSSION
Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.
PubMed: 37713161
DOI: 10.1097/CEH.0000000000000530 -
Statistics in Medicine Oct 2021Meta-analysis of rare event data has recently received increasing attention due to the challenging issues rare events pose to traditional meta-analytic methods. One... (Meta-Analysis)
Meta-Analysis Review
Meta-analysis of rare event data has recently received increasing attention due to the challenging issues rare events pose to traditional meta-analytic methods. One specific way to combine information and analyze rare event meta-analysis data utilizes confidence distributions (CDs). While several CD methods exist, no comparisons have been made to determine which method is best suited for homogeneous or heterogeneous meta-analyses with rare events. In this article, we review several CD methods: Fisher's classic P-value combination method, one that combines P-value functions, another that combines confidence intervals, and one that combines confidence log-likelihood functions. We compare these CD approaches, and we propose and compare variations of these methods to determine which method produces reliable results for homogeneous or heterogeneous rare event meta-analyses. We find that for homogeneous rare event data, most CD methods perform very well. On the other hand, for heterogeneous rare event data, there is a clear split in performance between some CD methods, with some performing very poorly and others performing reasonably well.
Topics: Humans; Likelihood Functions; Research Design
PubMed: 34219258
DOI: 10.1002/sim.9125 -
Cureus Dec 2022Background Knowing the predicting factors for difficult neuraxial blocks might help better plan the procedure. This study aimed to determine the predictors of failed...
Background Knowing the predicting factors for difficult neuraxial blocks might help better plan the procedure. This study aimed to determine the predictors of failed spinal arachnoid puncture procedures using artificial neural network (ANN) analysis. Methodology With approvals, prospectively collected data from 300 spinal arachnoid punctures in the operation theater of an academic institute having postgraduate anesthesia training were retrospectively evaluated. Fifteen variables from anthropo-demographic, spinal surface anatomy, procedure, and performers' experiences were fed as input for the ANN. A failed spinal arachnoid puncture procedure was defined as the requirement of more than three punctures, with three punctures but more than six passes, or if the performer handed over the procedure to another, considering it difficult after the second puncture. STATCRAFT v.2 software (Predictive Analytics Solutions Pvt. Ltd., Bengaluru, India) was used for ANN model generation. Considering the overfitting tendency of the ANN, Pr(>||) < 0.01 in the ANN was considered significant. The area under the receiver operating characteristic (AuROC) curve of the ANN model and its sensitivity and specificity were also assessed. Significant factors with multiple gradings were also evaluated for their statistical significance across the grades or classes using INSTAT software (Graphpad Prism, La Jolla, CA, USA); a two-tailed -value of <0.05 was considered significant. Results Interspinous process-based spine grade, performers' experience, and positioning difficulty were significant determinants of failed spinal arachnoid puncture procedures in the ANN model. The ANN model had an AuROC of 0.907, specificity of 0.976, and sensitivity of 0.385. The interclass comparison showed that increasing spinal grades and decreasing experiences were associated with increased pass and puncture. Conclusions The ANN model found the determinants of the failed spinal arachnoid puncture procedure well with good AuROC and specificity but poor sensitivity.
PubMed: 36699768
DOI: 10.7759/cureus.32891