Mary Cantrell

Developing and Testing Lay Literature About Breast Cancer Screening for African American Women

Written materials about breast cancer screening for African American women with low literacy skills are needed. Available materials were not at or below third-grade reading levels, were not culturally sensitive, and were not accurate in illustrating correct breast self-examination (BSE) techniques. Focus groups representing the target population helped the authors design a pamphlet describing how to perform BSE and a motivational picture book to help women overcome barriers to screening. The authors chose a food theme for the cover of the pamphlet written at a third-grade level and suggested a photographic version. In the motivational book, two women address barriers to screening and replace myths and fears with facts and actions. Data from 162 women showed that they learned from both the photographic and illustrated versions. Women in the photographic group found significantly more lumps in the silicone models, so the authors chose that version to use in final testing. Finally, nurses pretested a group of patients before they reviewed the materials and post-tested another group after they reviewed them. The group who had reviewed the materials had greater knowledge of and intent to follow the guidelines and received higher scores on BSE techniques.

Using standardized patients to teach breast evaluation to sophomore medical students

In response to the current emphasis on health maintenance and disease prevention, the authors developed a comprehensive education program in which sophomore medical students interview a standardized patient about breast problems and risk factors, receive one-on-one instruction from the standardized patient during the clinical breast examination, and practice recommendations for screening and instruction in breast self-examination. In this pilot study sophomore students who underwent the comprehensive education program were compared with students who received the traditional, didactic instruction and practiced on plastic breast models. The students who received the didactic instruction had mean scores on a multiple-choice knowledge-base pretest and posttest of 54.6% and 76.8%, respectively. The students who participated in the comprehensive education program had mean pretest and posttest scores of 51.2% and 78.5%, respectively. All students participated in a practical test of the clinical breast examination during an objective structured clinical examination. The students who had received the didactic instruction scored 69.9% (mean), compared with 84.1% for the students who had had the comprehensive education program. The comprehensive breast education program teaches medical students about risk factors, screening recommendations, and clinical breast examination more effectively than do traditional didactic methods.

The First Clinical Skill: Students Teach Students to Take Vital Signs

Abstract: Transition from the role of passive student to medical practitioner begins with learning the first clinical skill. This transition can be stressful for those experiencing it and to some extent by those coordinating it. Logistically, it requires demonstration of the techniques to the entire class by a single practitioner or to smaller groups of students by multiple practitioners. The former reduces the opportunity for close observation of technique and is less conducive to questions, while the latter requires multiple practitioners, which can be prohibitive given their already dense schedules. To reduce the stress for all involved and to maximize learning opportunities, an innovative approach to teaching the first skill, vital signs measurement, was developed. Small group instruction and practice were facilitated by senior medical student volunteers in a simulated outpatient clinic using actual equipment. Instruction was provided in a relaxed, but guided format. Students were provided with a lesson plan that detailed both, technique and brief physiology points, as well as check sheets to use during the lab and later as a refresher guide. The lesson plan, instructions for facilitators, and student check sheets were developed by a senior medical student and reviewed by the course faculty. Recruitment and briefing of student facilitators and conduct of the lab were also performed by the senior student. The purpose of this trend article is to describe the development of a new course format and to report our experience with implementation of the new format. It is intended to spark interest in applying similar approaches to other curricular issues.

High-Fidelity Hybrid Simulation of Allergic Emergencies Demonstrates Improved Preparedness for Office Emergencies in Pediatric Allergy Clinics

BACKGROUND Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. OBJECTIVE To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. METHODS Allergy clinics were invited to Arkansas Childrens Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. RESULTS Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). CONCLUSION Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.