Emmanuel Triby

Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention

Background:Population-based studies directed at promoting physical activity in youth have shown limited success in obesity prevention.Objective:To assess whether an intervention integrating environmental changes to induce sustained changes in physical activity, prevents overweight in adolescents.Design:Four-year randomized trial started in 2002 in eight middle schools of Eastern France. The intervention, randomized at school level, was designed to promote physical activity by changing attitudes through debates and attractive activities, and by providing social support and environmental changes encouraging physical activity.Subjects:Nine hundred and fifty four 12-year-old six-graders.Measurements:Body mass index (BMI), body composition, physical activity by questionnaire, plasma lipids and glucose, insulin resistance.Results:Intervention students had a lower increase in BMI (P=0.01) and age- and gender-adjusted BMI (P<0.02) over time than controls. The differences across groups of the age- and gender-adjusted BMI changes (95% confidence interval (CI)) were −0.29 (−0.51; −0.07) kg/m2 at 3 years, −0.25 (−0.51; 0.01) kg/m2 at 4 years. An interaction with baseline weight status was noted. The intervention had a significant effect throughout the study in initially non-overweight adolescents (−0.36 (−0.60;−0.11) kg/m2 for adjusted BMI at 4 years), corresponding to a lower increase in fat mass index (P<0.001). In initially overweight adolescents, the differences observed across groups at 2 years (–0.40 (−0.94; 0.13) kg/m2 for adjusted BMI) did not persist over time. At 4 years, 4.2% of the initially non-overweight adolescents were overweight in the intervention schools, 9.8% in the controls (odds ratio=0.41 (0.22; 0.75); P<0.01). Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised physical activity (P<0.0001), a decrease of TV/video viewing (P<0.01) and an increase of high-density cholesterol concentrations (P<0.0001).Conclusion:Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents. Our study provides evidence that prevention of obesity in youth is feasible.

An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory

Abstract Context. Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physicians most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. Purpose. This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years. Discussion. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

Impact of training periods in the emergency department on the motivation of health care students to learn

Objectives  Motivation is one of the most important factors for learning and achievement. The perceived value of the task, perceptions of self‐efficacy and beliefs about control of learning are the main determinants of motivation. They are highly influenced by the individual’s personal history and especially by significant past experiences. We assessed the impact of training periods in the emergency department on the motivation of health care students to learn in the field of emergency medicine.

Can teaching methods based on pattern recognition skill development optimise triage in mass-casualty incidents?

Background: Patient’s triage is a key element of mass-casualty incidents (MCIs) response, although performance of healthcare professionals in triage proved to be poor. It was assessed if specific teaching methods based on pattern recognition skill development can help healthcare students to improve their performance in triage. Methods: 128 medical and nursing students have been assessed while performing triage during disaster medicine exercises. Half of them (group 1) had previously been involved in a standard curriculum. The remaining half (group 2) benefited from specific teaching methods based on pattern recognition skill development. Results: Performance of group 2 was significantly higher compared with group 1 (p<0.01). Group 2 had a lower overtriage rate. Conclusions: Disaster medicine courses based on pattern recognition skill development improve triage performance of healthcare students during simulated MCI. This study may have a high impact on healthcare students and professionals’ education in the perspective of MCIs preparedness and response.

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.

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.

Interprofessional team debriefings with or without an instructor after a simulated crisis scenario : an exploratory case study

ABSTRACT The value of debriefing after an interprofessional simulated crisis is widely recognised; however, little is known about the content of debriefings and topics that prompt reflection. This study aimed to describe the content and topics that facilitate reflection among learners in two types of interprofessional team debriefings (with or without an instructor) following simulated practice. Interprofessional operating room (OR) teams (one anaesthesia trainee, one surgical trainee, and one staff circulating OR nurse) managed a simulated crisis scenario and were randomised to one of two debriefing groups. Within-team groups used low-level facilitation (i.e., no instructor but a one-page debriefing form based on the Ottawa Global Rating Scale). The instructor-led group used high-level facilitation (i.e., gold standard instructor-led debriefing). All debriefings were recorded, transcribed, and thematically analysed using the inductive qualitative methodology. Thirty-seven interprofessional team-debriefing sessions were included in the analysis. Regardless of group allocation (within-team or instructor-led), the debriefings centred on targeted crisis resource management (CRM) content (i.e., communication, leadership, situation awareness, roles, and responsibilities). In both types of debriefings, three themes emerged as topics for entry points into reflection: (1) the process of the debriefing itself, (2) experience of the simulation model, including simulation fidelity, and (3) perceived performance, including the assessment of CRM. Either with or without an instructor, interprofessional teams focused their debriefing discussion on targeted CRM content. We report topics that allowed learners to enter reflection. This is important for understanding how to maximise learning opportunities when creating education activities for healthcare providers that work in interprofessional settings.