Academic medicine : journal of the Association of American Medical Colleges
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Comparative Study
Unexpected collateral effects of simulation-based medical education.
Internal medicine residents who complete simulation-based education (SBE) in central venous catheter (CVC) insertion acquire improved skills that yield better patient care outcomes. The collateral effects of SBE on the skills of residents who have not yet experienced SBE are unknown. ⋯ SBE for senior residents had an effect on junior trainees, as evidenced by pretraining CVC insertion skill improvement across three consecutive years. SBE for a targeted group of residents has implications for skill acquisition among other trainees.
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Randomized Controlled Trial Comparative Study
Can eliminating risk stratification improve medical residents' adherence to venous thromboembolism prophylaxis?
Hospital-acquired venous thromboembolism (VTE) is a common and preventable adverse event that most patients are at risk of developing during their hospital stay. VTE prophylactic anticoagulation (chemoprophylaxis) is the preferred pharmacological assignment for reducing risk of VTE, but it is underused in current practices involving risk stratification (RS) for VTE prevention. The purpose of this study was to determine whether a protocol that eliminates the RS step (non-RS protocol) is more likely to lead residents to evidence-based VTE assignment than the currently used RS protocol. The non-RS protocol follows a methodology that reduces complexity by assuming that the risk of VTE is present and uses contraindications to determine appropriate VTE assignment. ⋯ This study used a new, streamlined protocol (non-RS), which improved VTE assignment and the use of chemoprophylaxis and simplified the process when compared with the use of a traditional RS protocol.
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Comparative Study
Do extratherapeutic factors affect residents' decisions to prescribe medication for erectile dysfunction in ethically challenging scenarios?
To examine residents' attitudes about prescribing medication for erectile dysfunction in ethically challenging scenarios. ⋯ Extratherapeutic factors influenced residents' decisions about prescribing medication for erectile dysfunction. Paternalistic attitude was the only attitudinal factor that affected likelihood of prescribing sildenafil. Residency programs should help trainees understand the balance between respecting patients' rights and protecting society, and between personal values and professional obligations, as well as how biases may affect patient care.