Teaching and learning in medicine
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PHENOMENON: Previous studies have not explored factors associated with decisions among neurology residents to pursue subspecialty training within neurology. Understanding career choices among neurology residents, particularly decisions regarding subspecialty training, is critical, as neurologists with specialized knowledge can help meet the needs of patients with specific disease conditions. This study addresses the knowledge gap about subspecialty training decisions by examining factors associated with neurology residents' interest in pursuing subspecialty training and the types of subspecialty training neurology residents consider. ⋯ The majority (approximately 81%) of residents expressed interest in subspecialty training. Resident demographic characteristics and educational debt did not influence interest in pursuing subspecialty training. Residents were more likely to express interest in subspecialty training when they participated in any neurology research (odds ratio [OR] = 2.39), 95% confidence interval (CI) [1.13, 5.07], p = .02, and indicated more interest in careers involving teaching (OR = 8.33), 95% CI [1.64, 42.19], p = .01. Considering the "medical content of subspecialty" as a more important factor approached but did not reach statistical significance (OR = 3.12), 95% CI [0.97, 10.06], p = .06. Insights: Participation in any neurology research and interest in careers involving teaching are associated with interest in subspecialty training among neurology residents. Further research is needed to determine whether exposure to research and teaching stimulates interest in subspecialty training and whether residents believe that subspecialty training is instrumental in pursuing an academic career.
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Randomized Controlled Trial
Impact of acute stress on resident performance during simulated resuscitation episodes: a prospective randomized cross-over study.
Medical trainees have identified stress as an important contributor to their medical errors in acute care environments. ⋯ Residents exposed to simulated resuscitation scenarios experienced significant stress responses irrespective of the presence of acute stressors during these scenarios. This anticipatory stressful response could impact on resident learning and performance and should be further explored.
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A battery of various psychometric assessments has been conducted on script concordance tests (SCTs) that are purported to measure data interpretation, an essential component of clinical reasoning. Although the breadth of published SCT research is broad, best practice controversies and evidentiary gaps remain. ⋯ Of the 6 scoring methods, 5-point scoring solutions generated more reliable measures of data interpretation than 3-point scoring methods. Data interpretation abilities were a function of experience at every level of item difficulty. Items categorized by type exhibited discriminatory power providing modest evidence toward the construct validity of SCTs.
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Medical student training and experience in cardiac arrest situations is limited. Traditional Advanced Cardiac Life Support (ACLS) teaching methods are largely unrealistic with rare personal experience as team leader. Yet Postgraduate Year 1 residents may perform this role shortly after graduation. ⋯ This course significantly improved knowledge and psychomotor skills. Critical actions required for resuscitation were much more common after training. ACLS training including high-fidelity simulation decreases time to CPR and DF and improves performance during resuscitation.
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The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. ⋯ The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.