Patrick Henn

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

BackgroundInternationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills.MethodStudents enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models.ResultsData were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest.ConclusionWe found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

Implementing peer tutoring in a graduate medical education programme

Background:  In modern times, peer tutoring methods have been explored in health care education for over 30 years. In this paper, we report our experience of implementing a peer‐tutoring approach to Clinical Skills Laboratory (CSL) training in the Graduate Entry in Medicine Programme (GEM) at University College Cork.

Designing Learning Outcomes for Handover Teaching of Medical Students using Group Concept Mapping

Purpose To develop, by consultation with an expert group, agreed learning outcomes for the teaching of handoff to medical students using group concept mapping. Method In 2013, the authors used group concept mapping, a structured mixed-methods approach, applying both quantitative and qualitative measures to identify an expert group’s common understanding about the learning outcomes for training medical students in handoff. Participants from four European countries generated and sorted ideas, then rated generated themes by importance and difficulty to achieve. The research team applied multidimensional scaling and hierarchical cluster analysis to analyze the themes. Results Of 127 experts invited, 45 contributed to the brainstorming session. Twenty-two of the 45 (48%) completed pruning, sorting, and rating phases. They identified 10 themes with which to select learning outcomes and operationally define them to form a basis for a curriculum on handoff training. The themes “Being able to perform handoff accurately” and “Demonstrate proficiency in handoff in workplace” were rated as most important. “Demonstrate proficiency in handoff in simulation” and “Engage with colleagues, patients, and carers” were rated most difficult to achieve. Conclusions The study identified expert consensus for designing learning outcomes for handoff training for medical students. Those outcomes considered most important were among those considered most difficult to achieve. There is an urgent need to address the preparation of newly qualified doctors to be proficient in handoff at the point of graduation; otherwise, this is a latent error within health care systems. This is a first step in this process.

A study of innovative patient safety education

Background:  Medical error continues to significantly harm patients, notwithstanding the continued efforts to improve the situation over the past decade. We report a pilot project using high‐fidelity simulation to integrate the World Health Organisation (WHO) patient safety curriculum into undergraduate medical education.

Age-Related Hearing Loss and Communication Breakdown in the Clinical Setting

Age-Related Hearing Loss and Communication Breakdown in the Clinical Setting Recent analyses have highlighted a significant increase in the rate of hearing loss in patients 60 years and older.1 The estimated prevalence of bilateral hearing loss greater than 25 dB is 27% among patients age 60 to 69 years; 55%, 70 to 79 years; and 79%, 80 years and older.1 The prevalence of medical errors is higher among older patients, and they are also among the most dependent users of the health care system.2 Failures in clinical communication are considered to be the leading cause of medical errors.2 Walsh and colleagues3 reported that improved communication between the medical teams and families could have prevented 36% of medical errors. However, the contribution of hearing loss to medical errors among older patients is nascent. While audiometry is an effective method of diagnosis of hearing impairment, not all impaired listeners will have the same speech comprehension, despite having similar pure-tone thresholds and configurations.4 In the present study, qualitative analysis was applied to semistructured interview data collected in 100 older adults 60 years and older. Baseline prevalence was calculated for communication breakdown in hospital and primary care settings among adults reporting hearing loss. We also identified common, discrete aspects of a clinical consultation that older adults with hearing loss may find difficult and which may be contributing toward medical error.

Burnout syndrome among non-consultant hospital doctors in Ireland: relationship with self-reported patient care

Objective Intensive workload and limited training opportunities for Irish non-consultant hospital doctors (NCHDs) has a negative effect on their health and well-being, and can result in burnout. Burnout affects physician performance and can lead to medical errors. This study examined the prevalence of burnout syndrome among Irish NCHDs and its association with self-reported medical error and poor quality of patient care. Methods A cross-sectional quantitative survey-based design. Setting All teaching hospitals affiliated with University College Cork. Participants NCHDs of all grades and specialties. Intervention(s) The following instruments were completed by all participants: Maslach Burnout Inventory-Human Service Survey (MBI-HSS), assessing three categories of burnout syndrome: Emotional exhaustion (EE), Personal Achievement (PA) and Depersonalization (DP); questions related to self-reported medical errors/poor patient care quality and socio-demographic information. Main outcome measure(s) Self-reported measures of burnout and poor quality of patient care. Results Prevalence of burnout among physicians (n = 265) was 26.4%. There was a significant gender difference for EE and DP, but none for PA. A positive weak correlation was observed between EE and DP with medical error or poor patient care. A negative association was reported between PA and medical error and reduced quality of patient care. Conclusions Burnout is prevalent among NCHDs in Ireland. Burnout syndrome is associated with self-reported medical error and quality of care in this sample population. Measures need to be taken to address this issue, with a view to protecting health of NCHDs and maintaining quality of patient care.

A metric-based analysis of structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation.

Objectives In this study we aimed to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The purpose was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. Design An educational study. Setting Simulation centre in a medical school. Participants 113 final-year medical students. Primary and secondary outcomes The primary outcome was to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The secondary outcome was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. Results During phone calls to a senior colleague 30% of students did not positively identify themselves, 29% did not identify their role, 32% did not positively identify the recipient of the phone call, 59% failed to positively identify the patient, 49% did not read back the recommendations of their senior colleague and 97% did not write down the recommendations of their senior colleague. Conclusions We identified a deficiency in our students skills to communicate relevant information via the telephone, particularly failure to repeat back and write down instructions. We suggest that this reflects a paucity of opportunities to practice this skill in context during the undergraduate years. The assumption that this skill will be acquired following qualification constitutes a latent error within the healthcare system. The function of undergraduate medical education is to produce graduates who are fit for purpose at the point of graduation.

Metric-Based Virtual Reality Simulation: A Paradigm Shift in Training for Mechanical Thrombectomy in Acute Stroke

Ischemic stroke is the second leading cause of death and the predominant cause of long-term disability in the Western world. Until recently, the standard treatment for ischemic stroke was intravenous administration of r-tPA (recombinant tissue-type plasminogen activator) within the accepted time limit of 4.5 hours from the onset of symptoms. Given later, risks such as intracranial hemorrhage outweigh the potential benefits. In large vessel occlusion (if no contraindication), r-tPA followed by mechanical thrombectomy improves outcomes. In a meta-analysis of large multicenter trials,1 patients receiving usual care (most often r-tPA) followed by mechanical thrombectomy showed significantly higher rates of functional independence at 90 days (46%) than those receiving usual care alone (26.5%). Benefits from mechanical thrombectomy have also been demonstrated in selected patient groups ≤162 and 24 hours3 after they were last known to be well. Despite the proven effectiveness of mechanical thrombectomy, access is limited. One of the main reasons is because of a shortage of interventional neuroradiologists trained to perform this procedure. Traditionally, doctors acquire their skills on new procedures on patients. However, image-guided procedures impose unique human factor challenges on the operator, which expose patients to potential risk during their learning curve. This current traditional process–driven approach to training4 (ie, procedure numbers done and time in training are assumed to signify skill) does not guarantee that the trained clinician has acquired the ability to effectively and readily execute as independent practitioners by the end of their training.5 A novel approach to enhance the learning experience and training of doctors to competently perform mechanical thrombectomy is metric-based virtual simulation training to proficiency.5 A group of senior interventional neuroradiologists and the ASSERT Center at University College Cork, in conjunction with industry partner Mentice AB (Gothenburg, Sweden), have pioneered this method to help prepare physicians …

Behind your very eyes: a response to Kok and Jarodzka

Kok and Jarodzka’s discussion of the parameters of eye movement technology within medical education highlights interesting opportunities whereby technology can enhance learning. The authors remind medical educators of the twin and distinct domains of behaviour and cognition, where one cannot invariably infer mental processes from a behavioural outcome, even when the latter occurs without the subject’s explicit awareness.

Fit for practice: are we there yet?

The transition from medical student to medical practitioner is known to be difficult. Medical education has undergone great change in recent years in an attempt to address this and to produce doctors who are fit for purpose. In spite of these changes, it appears that newly qualified medical graduates continue to describe their transition to practice as stressful, particularly in relation to issues of responsibility, uncertainty and lack of support from senior colleagues (Brennan et al. 2010). In 2005 Finucane and O’Dowd found that 68% of interns working in Ireland felt that they had been inadequately prepared for internship by medical school. Subsequently, the Medical Council of Ireland made a number of recommendations to ensure that undergraduate training is an effective preparation for internship. In an attempt to assess the success or otherwise of these changes and recommendations, we carried out a qualitative assessment of intern preparedness for practice in a large teaching hospital in the South of Ireland in 2010. This study found that there are still many difficulties with the transition from medical student to medical practitioner. Although participants believed that they had good theoretical knowledge, they felt poorly prepared to apply it in practice. Particular areas of concern were the practical application of acute medicine and day-to-day issues regarding prescribing and common calls. Challenges of the job for which the participants had felt unprepared included task overload, prioritization, and sleep deprivation. They described many negative emotions, including anxiety, uncertainty, isolation and guilt. This study identifies that interns in Ireland continue to feel unprepared for several key aspects of practice in the first year of their medical career. This has implications for what is taught and how it is taught in the undergraduate medical curriculum, suggesting a need for change to produce graduates who are better prepared for the job they do.