Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.

Educational Program for Physiologic Monitor Use and Alarm Systems Safety: A Toolkit.

Background: Problem-based learning (PBL) is an inquiry-based learning strategy which is learner centered and facilitates group discussion and critical thinking. Case-based learning (CBL), which is a more guided approach of PBL, enables students to learn within the context of patients and formulate their knowledge around patients' scenarios. Midweek (MW) activity is an important educational activity in the internal medicine residency program (IMRP). CBL has shown many benefits in postgraduate education. The aim of our study was to describe the implementation of a teaching resident's management of acute medical conditions encountered during their call utilizing the CBL format and to evaluate resident satisfaction with the new teaching style. Methods: This study describes the implementation of CBL in residents' education at the IMRP. CBL was introduced in five of the 10 acute medical sessions taught in the noon activity. A mixed-method study was employed using both a structured questionnaire and a focus group to compare the two methods to evaluate the residents' satisfaction and perception of knowledge acquisition. Results: The focus group discussion showed that sessions conducted in CBL format were more engaging, interactive, and resulted in better knowledge acquisition through sharing and peer-to-peer teaching than the traditional lecture format. Thirty-nine out of 83 (47%) residents ranging from PGY2 to PGY4 responded to the survey. Overall satisfaction with CBL was good. Sixty-four percent preferred it over the lecture format; 87% found that they did improve their knowledge; 84% agreed that they were excellent and more interactive. Seventy-nine percent stated that they would like to have this type of teaching in the MW activity sessions. Conclusion: Based on the present study, we conclude that incorporation of CBL resulted in more engagement, interaction, peer-to-peer education, and overall residents' satisfaction. The key elements for a successful implementation of this format are both instructors' and residents' orientation and careful selection of the case scenarios (problems) that trigger the learning process. Incorporation of various teaching strategies in residents' education is mandatory to enhance learning and create excellent educational experiences.

It is all about patients' stories: Case-based learning in residents' education.

Objective Subspecialisation is increasingly a fundamental part of the contemporary practice of medicine. However, little is known about how medical trainees learn in the modern era, and particularly in growing and relatively new subspecialties, such as adult CHD. The purpose of this study was to assess institutional-led and self-directed learning strategies of adult CHD fellows. Methods This international, cross-sectional online survey was conducted by the International Society for Adult Congenital Heart Disease and consisted primarily of categorical questions and Likert rating scales. All current or recent (i.e., those within 2 years of training) fellows who reported training in adult CHD (within adult/paediatric cardiology training or within subspecialty fellowships) were eligible. Results A total of 75 fellows participated in the survey: mean age: 34 ± 5; 35 (47%) female. Most adult CHD subspecialty fellows considered case-based teaching (58%) as "very helpful", while topic-based teaching was considered "helpful" (67%); p = 0.003 (favouring case-based). When facing a non-urgent clinical dilemma, fellows reported that they were more likely to search for information online (58%) than consult a faculty member (29%) or textbook (3%). Many (69%) fellows use their smartphones at least once daily to search for information during regular clinical work. Conclusions Fellows receiving adult CHD training reported a preference for case-based learning and frequent use of online material and smartphones. These findings may be incorporated into the design and enhancement of fellowships and development of online training resources.

Learning strategies among adult CHD fellows

Introduction

Resident physicians are routinely required to evaluate and manage patients with tachyarrhythmias. We developed a comprehensive workshop in an effort to improve residents’ competence and confidence at managing tachyarrhythmias.

Methods

A total of 55 residents attended the workshop and underwent pre- and post-testing to assess their competence of identifying and managing different arrhythmia. The participants were also asked to describe the comfort level managing these patients. After the pre-test, they participated in an interactive one hour session in which a cardiologist discussed common tachyarrhythmias and their management. For the next hour, the residents were then divided into groups of four to five. Using mannequins connected to heart monitors, the residents would be provided with a clinical vignette and asked to identify the heart rhythm and suggest management. A mock medication cart, and actual cardioverters-defibrillators were available. If the resident physician were to deliver cardioversion appropriately, the rhythm would change to sinus, and the patient’s hemodynamics would improve, thus providing live feedback for correct management.

Results

Amongst the 55 residents that participated in this study, the mean scores were 13.1 for pre-testing and 17.9 for post-testing, respectively (p = 0.0001). Residents’ mean comfort levels at managing tachyarrhythmias were 2.6 prior to testing and 3.6 post-testing (p = 0.0001).

Conclusion

We demonstrate that a two-hour focused tachyarrhythmia workshop significantly improved residents’ comfort level and competence in managing patients with tachyarrhythmia. By focusing on the higher levels of Bloom’s taxonomy such as analysis, synthesis and evaluation, we were able to improve the educational experience for our resident physicians.

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Applying the Principles of Bloom's Taxonomy to Managing Tachyarrhythmia: Results of a Tachyarrhythmia Workshop.

INTRODUCTION  A workshop was designed to evaluate whether high-fidelity simulation with interactive case discussion could improve resident physician knowledge and comfort interpreting and managing bradyarrhythmias.  Methods: All the residents completed a pre-test and then participated in a one-hour interactive presentation, which included practice interpreting rhythm strips and 12-lead electrocardiograms. Forty-four residents were assigned to the intervention group and completed 10 simulated cases using a mannequin, a real defibrillator/external pacemaker, a medication cart, and a simulated telemetry monitor displaying real-time electrocardiograms under the guidance of two instructors. Seventeen residents were assigned to the control group and completed the same 10 cases using interactive discussion with the same instructors but without the use of the high-fidelity simulation models. All residents underwent post-testing.  Results: For the intervention group, the mean pre- and post-test knowledge scores were 13.93 and 17.28 (p=0.0001), and the mean pre- and post-test comfort scores were 2.92 and 4.24 (p=0.0001). For the control group, the mean pre- and post-test knowledge scores were 14.52 and 18.00 (p=0.005), and the mean pre- and post-test comfort scores were 2.97 and 4.35 (p=0.001). There were no statistically significant differences between pre-test and post-test knowledge and comfort scores for the two groups (p=0.633, p=0.421, p=0.177). CONCLUSION  Interactive workshops help improve resident knowledge and comfort with identifying and managing bradycardias. The use of high-fidelity simulation models may not be superior to a similar interactive learning experience without the use of high-fidelity simulation tools.

Does Use of High-fidelity Simulation Improve Resident Physician Competency and Comfort Identifying and Managing Bradyarrhythmias?

Continuous medical training (CMT) has proved to be an effective method to improve and sustain professional medical competence.1,2 Consequently, several studies have assessed the effectiveness and the impact of different strategies and educational methodologies applied to CMT. However, the available evidence in this context is relatively scarce, limiting the possibility to draw definitive conclusions. Some studies have suggested that, among the different approaches, those that generate a higher impact in learners and effectively change their clinical practice are those based on interactive methodologies, mainly those using simulation and case-based learning as pivotal learning elements.1,3,4 Additionally, the audience in postgraduate CMT seems to show a more positive attitude towards these interactive programs that engage students in their learning process assigning them an active role.4-6 Despite this, traditional training strategies based on presentations and lectures are still predominant.3 The use of cases or problems as the basis of learning strategies is more common in pregraduate training.7 However, its use in post-graduate training and long-life-learning is rare in spite of evidence suggesting stronger learning outcomes.3,7-10

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Eduardo Franco Diez

Papers

Training in management of arrhythmias for medical residents: a case-based learning strategy.

Arritmogénesis de las secuencias corto-largo-corto