Jill Graygo

Use of mobile learning module improves skills in chest tube insertion

BACKGROUND Just-In-Time Learning is a concept increasingly applied to medical education, and its efficacy must be evaluated. MATERIALS AND METHODS A 3-minute video on chest tube insertion was produced. Consenting participants were assigned to either the video group, which viewed the video on an Apple® iPod Touch immediately before chest tube insertion, or the control group, which received no instruction. Every participant filled out a questionnaire regarding prior chest tube experience. A trained clinician observed participants insert a chest tube on the TraumaMan® task simulator, and assessed performance using a 14-item skills checklist. RESULTS Overall, 128 healthcare trainees participated, with 50% in the video group. Participants included residents (34.4%, n = 44), medical students (32.8%, n = 42), and U.S. Army Forward Surgical Team members (32.8%, n = 42). Sixty-nine percent of all participants responded that they had never placed a chest tube, but 7% had placed more than 20. Only 25% of the participants had previously used TraumaMan®. Subjects who viewed the video scored better on the skills checklist than the control group (11.09 ± 3.09 versus 7.17 ± 3.56, P < 0.001, Cohens D = 1.16). Medical students (9.33 ± 2.65 versus 4.52 ± 3.64, P < 0.001), Forward Surgical Team members (10.07 ± 2.52 versus 8.57 ± 3.22, P < 0.001), anesthesia residents (8.25 ± 2.56 versus 5.9 ± 2.23, P = 0.017), and subjects who had placed fewer than 10 chest tubes (9.7 ± 3 versus 6.6 ± 3.9, P < 0.001) performed significantly better with the video. CONCLUSIONS The procedural animation video is an effective medium for teaching procedural skills. Embedding the video on a mobile device, and allowing trainees to access it immediately before chest tube insertion, may enhance and standardize surgical education for civilians and military personnel.

Influence of social networking websites on medical school and residency selection process

Background Social networking (SN) has become ubiquitous in modern culture. The potential consequences of revealing personal information through SN websites are not fully understood. Objective To assess familiarity with, usage of, and attitudes towards, SN websites by admissions offices at US medical schools and residency programmes. Methods A 26-question survey was distributed in autumn 2009 to 130 US medical school admissions officers and 4926 residency programme directors accredited by the Accreditation Council for Graduate Medical Education. Results A total of 600 surveys were completed, with 46 (8%) respondents who self-identified as reviewing only medical school applications, 511 (85%) who reported reviewing residency programme applications and 43 (7%) who reported reviewing both. 90/600 (15%) medical schools or programmes maintain profiles on SN websites and 381/600 (64%) respondents reported being somewhat or very familiar with searching individual profiles on SN websites. While a minority of medical schools and residency programmes routinely use SN websites in the selection process (53/600; 9%), more than half of respondents felt that unprofessional information on applicants’ SN websites could compromise their admission into medical school or residency (315/600; 53%). Conclusions SN websites will affect selection of medical students and residents. Formal guidelines for professional behaviour on SN websites might help applicants avoid unforeseen bias in the selection process.

Mobile Learning Module Improves Knowledge of Medical Shock for Forward Surgical Team Members

OBJECTIVE Acute trauma care is characterized by dynamic situations that require adequate preparation to ensure success for military health professionals. The use of mobile learning in this environment can provide a solution that standardizes education and replaces traditional didactic lectures. METHODS A comparative evaluation with a pre-post test design regarding medical shock was delivered via either a didactic lecture or a mobile learning video module to U.S. Army Forward Surgical Team (FST) members. Participants completed a pretest, were randomly assigned to treatment group by FST, and then completed the post-test and scenario assessment. RESULTS One-hundred and thirteen FST members participated with 53 in the mobile learning group and 60 in the lecture group (control). The percent mean score for the mobile learning group increased from 43.6 to 70 from pretest to post-test, with a scenario mean score of M = 56.2. The percent mean score for the control group increased from 41.5 to 72.5, with a scenario mean score of M = 59.7. The two-way analysis of variance mean score difference was 26.4 for the mobile learning group and 31.0 for the control, F = 2.18, (p = 0.14). CONCLUSIONS Mobile learning modules, coupled with a structured assessment, have the potential to improve educational experiences in civilian and military settings.

The Benefits and Tradeoffs for Varied High-Severity Injury Risk Thresholds for Advanced Automatic Crash Notification Systems

Objectives: The objectives of this study are to (1) characterize the population of crashes meeting the Centers for Disease Control and Prevention (CDC)-recommended 20% risk of Injury Severity Score (ISS) > 15 injury and (2) explore the positive and negative effects of an advanced automatic crash notification (AACN) system whose threshold for high-risk indications is 10% versus 20%. Methods: Binary logistic regression analysis was performed to predict the occurrence of motor vehicle crash injuries at both the ISS > 15 and Maximum Abbreviated Injury Scale (MAIS) 3+ level. Models were trained using crash characteristics recommended by the CDC Committee on Advanced Automatic Collision Notification and Triage of the Injured Patient. Each model was used to assign the probability of severe injury (defined as MAIS 3+ or ISS > 15 injury) to a subset of NASS-CDS cases based on crash attributes. Subsequently, actual AIS and ISS levels were compared with the predicted probability of injury to determine the extent to which the seriously injured had corresponding probabilities exceeding the 10% and 20% risk thresholds. Models were developed using an 80% sample of NASS-CDS data from 2002 to 2012 and evaluations were performed using the remaining 20% of cases from the same period. Results: Within the population of seriously injured (i.e., those having one or more AIS 3 or higher injuries), the number of occupants whose injury risk did not exceed the 10% and 20% thresholds were estimated to be 11,700 and 18,600, respectively, each year using the MAIS 3+ injury model. For the ISS > 15 model, 8,100 and 11,000 occupants sustained ISS > 15 injuries yet their injury probability did not reach the 10% and 20% probability for severe injury respectively. Conversely, model predictions suggested that, at the 10% and 20% thresholds, 207,700 and 55,400 drivers respectively would be incorrectly flagged as injured when their injuries had not reached the AIS 3 level. For the ISS > 15 model, 87,300 and 41,900 drivers would be incorrectly flagged as injured when injury severity had not reached the ISS > 15 injury level. Conclusions: This article provides important information comparing the expected positive and negative effects of an AACN system with thresholds at the 10% and 20% levels using 2 outcome metrics. Overall, results suggest that the 20% risk threshold would not provide a useful notification to improve the quality of care for a large number of seriously injured crash victims. Alternately, a lower threshold may increase the over triage rate. Based on the vehicle damage observed for crashes reaching and exceeding the 10% risk threshold, we anticipate that rescue services would have been deployed based on current Public Safety Answering Point (PSAP) practices.

The Use of Observation and Interview Methods for Assessing Issues in Patient Care in the Resuscitation Unit of a Level-1 Trauma Center

Although traumatic injury is the leading cause of death in the U.S. for people between the ages of one and 44, we lack important knowledge about how the various activities and processes within the resuscitation units of trauma care systems can impact the management of patient care. This article reports on a research study that involved the complementation of observation and interview methods for identifying and assessing a broad array of issues and concerns within this highly complex critical care setting in a large level-1 trauma center. Data from observations were collected on 27 days, and subsequently used to guide semi-structured interviews with 22 health care workers representing different specialties responsible for patient care within the resuscitation unit. The complementation of observation and interview data afforded the opportunity to validate issues that were observed while providing a richer understanding of these issues as a basis for formulating intervention strategies.

Etiology of fatal thoracic aortic injuries: Secondary data analysis

ABSTRACT Objectives: Motor vehicle crashes remain a leading cause of death in the United States (US). Thoracic aortic dissection due to blunt trauma remains a major injury mechanism, and up to 90% of these injuries result in death on the scene. The objective of this study is to understand the modern risk factors and etiology of fatal thoracic aortic injuries in the current US fleet. Methods: Using a unique, linked, Fatality Analysis Reporting System (FARS) and Multiple Cause of Death (MCOD) database from 2000–2010, 144,169 drivers over 16 years of age who suffered fatal injuries were identified. The merged database provides an unparalleled fidelity for identifying thoracic aortic injuries due to motor vehicle accidents. Thoracic aortic injuries were defined by ICD-10 codes S250. Univariate and multivariate logistic regression models for presence of any thoracic aortic injuries were fitted. Age, gender, BMI weight categories, vehicle class, model year, crash type/direction, severity of crash damage, airbag deployment location, and seatbelt use, fatal injury codes, and location of injury were considered. Odds ratios (OR) and corresponding 95% confidence intervals (95%CI) are calculated. Results: There were 2953 deaths (2.10%) related to thoracic aortic injuries that met the inclusion criteria. Nearside crashes were associated with an increased odds (OR = 1.42, 1.1-1.83), while rollover crashes (OR =.44,.29-.66) were associated with a reduced odds of fatal thoracic aortic injury. Using backward selection on the full multivariate model, the only significant model effects that remained were vehicle type, crash type, body region, and injury type. Conclusions: The increased prevalence of fatal thoracic aortic injury in nearside crashes, increasing age, and vehicle type provide some insight into the current US fleet. Important factors, including model year, had significantly lower levels of the injury in univariate analysis, demonstrating the effect of safety improvements in newer model vehicles. Further study of this fatal injury is warranted, including comparisons of those who survive the injury.