Christine Ammirati

Are schoolteachers able to teach first aid to children younger than 6 years? A comparative study

Objectives This study was designed to assess the knowledge acquired by very young children (<6 years) trained by their own teachers at nursery school. This comparative study assessed the effect of training before the age of 6 years compared with a group of age-matched untrained children. Setting Some schoolteachers were trained by emergency medical teams to perform basic first aid. Participants Eighteen classes comprising 315 pupils were randomly selected: nine classes of trained pupils (cohort C1) and nine classes of untrained pupils (cohort C2). Primary and secondary outcome measures The test involved observing and describing three pictures and using the phone to call the medical emergency centre. Assessment of each child was based on nine criteria, and was performed by the teacher 2 months after completion of first aid training. Results This study concerned 285 pupils: 140 trained and 145 untrained. The majority of trained pupils gave the expected answers for all criteria and reacted appropriately by assessing the situation and alerting emergency services (55.7−89.3% according to the questions). Comparison of the two groups revealed a significantly greater ability of trained pupils to describe an emergency situation (p<0.005) and raise the alert (p<0.0001). Conclusions This study shows the ability of very young children to assimilate basic skills as taught by their own schoolteachers.

Insights into emergency physicians' minds in the seconds before and into a patient encounter.

Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians’ minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an “own-point-of-view-perspective”. 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient’s position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient’s overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.

Fighting violence against health workers: a way to improve quality of care?

Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

Do emergency physicians trust their patients

The primary focus of research on the physician-patient relationship has been on patients’ trust in their physicians. In this study, we explored physicians’ trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an “own point of view perspective”. The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients’ accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as “reliable” or “unreliable” on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making.

An innovative approach to assess teaching skills in medical students

healthcare professionals for their contribution to creating an exceptional learning environment, we have not yet made the cultural impact we hope to achieve. We believe there is an opportunity to capitalize on a strategy that is already being employed: incentivizing physicians, perhaps through career opportunities or monetary means. Within the hospital setting, patient satisfaction surveys are utilized as a metric to identify excellence in patient care. Patients have the opportunity to highlight positive experiences that shape the environment of the hospital system. So, too, should medical students have the opportunity to acknowledge faculty and residents for their extraordinary contributions to creating a positive learning environment, not only at the end of clinical clerkships but throughout the preclinical years. An incentivized system would set the precedent of excellence being rewarded in a tangible manner. It would foster the desire to strive for a teaching and clinical environment of the highest quality. Within the high-stress environment of the healthcare field, it is easy to forget the molding of minds that is occurring around every corner and the need for an environment that fosters both excellence and job satisfaction. Let us shift the current culture to one that is demanding yet engaging, difficult yet encouraging, by not only recognizing but incentivizing those who continuously set a high bar of professionalism within the medical learning environment.

Moving a hospital: simulation – a way to co-produce safety healthcare facilities

Moving a hospital is a critical period for quality and safety of healthcare. Change is very stressful for professionals. Workers who have experienced relocation of their place of work report deterioration in health status. Building a new hospital or restructuring a unit could provide an opportunity for improving safety and value in healthcare and for ensuring better quality of worklife for the staff. We used in situ simulation to promote experiential learning by training healthcare workers in the workplace in which they are expected to use their skills. In situ simulation was a way to design, plan, assess and implement a new healthcare environment before opening its doors for patient care. We can envisage that simulation will soon be used formally to identify potential problems in healthcare delivery and in staff quality of worklife in new healthcare facilities. Simulation is a way to co-produce a safe and valuable healthcare facility.