Victoria Brazil

A simulated emergency department for medical students.

During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment.

How we ''breathed life'' into problem-based learning cases using a mobile application

Abstract Background: Problem-based learning (PBL) has been widely adopted in medical education. Learners become bored with paper-based cases as they progress through their studies. Aim: To breathe life (i.e. develop virtual patients) into paper-based PBL cases. Methods: The “patients” in paper-based PBL cases in one Year 2 were transformed into virtual patients by simulated patients role-playing and the videos and associated patient data uploaded to Bond’s Virtual Hospital, a mobile Application. In unsupervised “clinical teams”, second-year students undertook “ward rounds” twice a week, prompted by a virtual consultant and registered nurse. Immediately following the “ward rounds”, they met with a clinician facilitator to discuss their “patients”. Results: Apart from some minor technical issues, the experience was rated positively by students and clinical facilitators. They claimed that it provided students with a sense of what happens in the real world of medicine. The group work skills students had developed during PBL stood them in good stead to self-manage their “clinical teams”. Conclusions: This more authentic PBL experience will be extended to earlier semesters as well as later in the curriculum as the virtual hospital can be used to expose learners to a profile of patients that may not be guaranteed during hospital rounds.

Intern underperformance is detected more frequently in emergency medicine rotations.

To determine the frequency and nature of intern underperformance as documented on in‐training assessment forms.

Comparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques.

Objective: Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations.

Evidence‐Based Management in Practice: Opening Up the Decision Process, Decision‐Maker and Context

Evidence‐based management (EBM) has been subject to a number of persuasive critiques in recent years. Concerns have been raised that: EBM over‐privileges rationality as a basis for decision‐making; ‘scientific’ evidence is insufficient and incomplete as a basis for management practice; understanding of how EBM actually plays out in practice is limited; and, although ideas were originally taken from evidence‐based medicine, individual‐situated expertise has been forgotten in the transfer. To address these concerns, the authors adopted an approach of ‘opening up’ the decision process, the decision‐maker and the context (Langley et al. ([Langley, A., 1995]). ‘Opening up decision making: the view from the black stool’, Organization Science, 6, pp. 260–279). The empirical investigation focuses on an EBM decision process involving an operations management problem in a hospital emergency department in Australia. Based on interview and archival research, it describes how an EBM decision process was enacted by a physician manager. It identifies the role of ‘fit’ between the decision‐maker and the organizational context in enabling an evidence‐based process and develops insights for EBM theory and practice.

Clinical supervisors and cultural competence

To investigate how clinical supervisors of junior doctors provide feedback and assessment on cultural competence, one of several professionalism skills outlined in the Australian Curriculum Framework for Junior Doctors.

Balancing quantity and quality in emergency medicine training for interns

The introduction of a national registration standard for internship at a time of marked growth in graduate numbers provides an opportunity to review the value and cost of emergency medicine (EM) terms for interns. Given that new graduates are no longer mandated to complete an ED-based rotation, would quality be enhanced by providing a smaller number with a more comprehensive experience? EM terms during internship are greatly valued by junior doctors. They provide an important experience in generalist medicine as they expose interns to a broad range of undifferentiated acute illness not often encountered in other rotations. In addition, EDs can facilitate the acquisition of core competencies listed in the clinical management, communication and professionalism domains of the Australian Curriculum Framework for Junior Doctors. A recent study has demonstrated that EM terms also have a crucial role in assessing junior doctor performance and detecting interns who are not ready for more independent practice. The requirement for interns to take primary responsibility for undifferentiated patients, along with proximity and depth of supervision, contribute to the EM rotation being an important ‘acid test’. Assessments undertaken in the EM term might also be more valid because multiple supervisors are involved. Despite these educational benefits, workforce and clinical service reforms are making it more difficult for EDs to deliver quality training for interns. Medical graduate numbers have increased by approximately 10% per annum since 2007, resulting in significant capacity issues at the prevocational level. Providing a sufficient number of ED placements has proved challenging, and the EM term now represents a major ‘bottleneck’ in intern training. The increasing requirement for intern placements comes at a time of growing demand for emergency medical services, and intensifying pressure on EDs to achieve time-based targets. Concerns that the National Emergency Access Target will impact on training quality have previously been published in this journal. Despite these challenges, the availability of senior ED staff to provide effective supervision represents the most significant constraint in expanding capacity. Coinciding with the increase in graduate numbers, the Medical Board of Australia has released a national standard for achieving general registration, which will apply for all Australian and New Zealand medical graduates commencing their internship in 2014. The new arrangements have been introduced to achieve national consistency in intern training and will be supported by an accreditation framework that is currently being developed by the Australian Medical Council. In addition to 10-week terms in medicine and surgery, interns will need to obtain at least 8 weeks experience in ‘emergency medical care’ (EMC). This rotation does not need to be in a medium or large ED, as has previously been required by most states and territories. As a consequence, the EMC term will increase flexibility for health services by allowing some general practices and smaller hospitals to substitute for EDs. Primary care settings can provide junior doctors with valuable training; however, the equivalence of this experience – in clinical, supervisory, assessment and other aspects – to an ED term is questionable. Unfortunately the lack of metrics for internship outcomes makes evidence-based decision making impossible in this regard, leaving policy makers with a combination of expert opinion and pragmatism on which to base decisions.

Strategies for Teaching Evidence-Based Management What Management Educators Can Learn From Medicine

Evidence-based management (EBMgt) is a growing literature stream in management education which contends that management decision making should be informed by the best available scientific evidence (Rousseau, 2006). Encouraged by the success of evidence-based practice in the field of medicine, advocates of EBMgt have increasingly called for management educators to develop graduates into evidence-based practitioners who—like physicians—value and use evidence in their daily practice in organizations. In this essay, we contribute to these debates by exploring three strategies that are used in medicine to train physicians to engage with evidence: embedding the normative foundation of evidence in problem-solving routines, role modelling being a reflective research consumer, and creating teachable moments through lived experience of research. We consider whether and how these strategies can be adapted to inform teaching the teaching of EBMgt. Drawing on these insights from physician training, we suggest a range of methods and techniques that management educators can implement in their teaching to facilitate student learning about evidence-based practice. We also consider the challenge of developing evidence-based cultures in organizations.

Developing junior doctors’ prescribing practices through collaborative practice: Sustaining and transforming the practice of communities

ABSTRACT Prescribing in acute healthcare settings is a complex interprofessional process with a high incidence of medication errors. Opportunities exist to improve prescribing learning through collaborative practice. This qualitative interview-based study aimed to investigate the development of junior doctors’ prescribing capacity and how pharmacists contribute interprofessionally to this development and the prescribing practices of a medical community. The setting for this study was a large teaching hospital in Australia where ethical approval was gained before commencing the study. A constructionist approach was adopted and the interviews were held with a purposive sample of 34 participants including junior doctors (n = 11), clinical supervisors (medical; n = 10), and pharmacists (n = 13). Informed by workplace learning theory, interview data were thematically analysed. Three key themes related to pharmacists’ contributions to prescribing practices emerged: building prescribing capacities of junior doctors through guidance and instruction; sustaining safe prescribing practices of the community in response to junior doctor rotations; and transforming prescribing practices of the community through workplace learning facilitation and team integration. These findings emphasize the important contributions made by pharmacists to building junior doctors’ prescribing capacities that also assist in transforming the practices of that community. These findings suggest that rather than developing more conventional education programs for prescribing, further consideration should be given to interprofessional collaboration in everyday activities and interactions as a means to promote both effective learning for individuals and advancing the enactment of effective prescribing practice.

You can't put a value on that… Or can you? Economic evaluation in simulation-based medical education

Simulation-based medical education (SBME) is often resource-intensive, yet rigorous evaluation of the costs and benefits of simulation programmes or activities is rare. Lin et al. raise the important issue of economic evaluation of SBME and offer guidance on its implementation by exploring challenges and opportunities. We offer support for discipline in the economic evaluation of simulation while urging caution in what and how we ascribe value as integral to the economic evaluation process. Consider how you might place a value on SBME in the following scenarios: