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Background: Critical thinking is essential for the accurate diagnosis and management of patients. It is correlated with academic success. Objective: Our objective was to design a novel tool for interactive online learning to improve knowledge and to assess trainees' critical thinking skills using the framework of the American Philosophical Association (APA). Methods: Residents, fellows and students participated in an online, self-directed case-based vignette activity to learn malaria diagnosis and management. Pre and post-tests with multiple choice and open-ended case-based questions assessed knowledge and critical thinking. Comparison between pre and post-test scores across subgroups were performed using paired t-tests or one-way ANOVA. Results: Between 4 April 2017 to 14 July 2019, 62 of 75 (82%) eligible subjects completed both the pre and the post-test. Improved post-test scores occurred in 90% of medical students, p=0.001, 77% of residents, p<0.001, 60% of fellows, p=0.72 and 75% of trainees overall, p=<0.001. Fellows had higher pre-test scores than students or residents but there was no difference by level of training on the post-test. Conclusions: This interactive online learning activity effectively imparted medical knowledge and improved trainee responses to questions requiring critical thinking. To our knowledge, this is the first time the APA's critical thinking framework has been incorporated into interactive online learning and assessment of critical thinking skills in medical trainees. We applied this innovation specifically in global health education, but there is obvious potential to expand it to a wide variety of areas of clinical training. [ABSTRACT FROM AUTHOR]

Purpose:Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery. Methods:Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome. Results:Being on modified job duty (OR = .17, 95%CI: 0.03–0.94), and having a worker’s compensation claim (OR = 0.08, 95%CI: 0.01–0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR = 11.96, 95%CI: 2.91–49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR = 0.95, 95%CI: 0.91–0.98) and the FABQ_work subscale (OR = 0.92, 95%CI: 0.87–0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR = 8.9, 95%CI 1.75–45.7) and FABQ_work subscale score ≤25 (OR = 15.3, 95%CI 2.3–101.9) remained significant. Discussion:Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability.Implications for RehabilitationImpairment-based shoulder measurements were not strong predictors of patient-reported outcome.Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability.Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels. [ABSTRACT FROM AUTHOR]

Background:Understanding preoperatively available factors that predict valid, patient-reported outcomes following rotator cuff repair can assist clinicians and their patients in making an informed, shared-decision on rotator cuff repair, and assist in setting an evidence-based prognosis. Objectives:To perform a systematic review of the preoperative factors related to patient-reported outcome following rotator cuff repair. Methods:A systematic review of the literature was performed to identify studies analyzing the relationship of preoperative factors to valid, patient-reported outcome measures. To be included in the review, outcome had to be measured by at least one valid upper extremity or shoulder-specific patient-reported outcome. Results:Twenty-three studies met the criteria for inclusion. Of these, 15 studies scored 3 or less on a 7-point scale of study quality indicating a paucity of strong trials investigating these prognostic factors. Prognostic factors reviewed included age, sex, worker’s compensation status, involvement of dominant arm, fatty infiltration of the cuff musculature, duration of symptoms, comorbidities, and smoking status. Increasing age predicted worse Disabilities of Arm, Shoulder and Hand Scores (DASH) but did not predict outcome of any other patient-reported outcome. A worker’s compensation claim predicted a negative impact on patient-reported outcome. Evidence for the remaining factors indicated they do not predict patient-reported outcome. Conclusion:Six of the eight preoperative factors reviewed did not show a relationship with patient-reported outcome following rotator cuff repair. Evidence indicates a worker’s compensation claim negatively impacts patient-reported outcomes and increasing age resulted in a less favorable DASH score. However, age was not predictive of other patient-reported outcomes such as the Constant score or American Shoulder and Elbow Surgeons Shoulder Score. Overall quality of the included studies was low and future studies with stronger methodologies should be conducted. [ABSTRACT FROM PUBLISHER]

Purpose: Recently the Accreditation Council for Graduate Medical Education mandated decreased shift duration for intern physicians to no more than 16 hours. Such work-hour restrictions are likely to increase patient care hand-offs. It is well accepted that sign-out (i.e., hand-off) processes are error prone and lack standardization. Moreover, many residency programs do not evaluate sign-out. We designed and tested whether a sign-out evaluation process could be implemented to improve written sign-out. Method: Based on observed sign-out deficiencies at our institution we adapted a simple curriculum incorporating the SIGNOUT mnemonic, which we paired with weekly faculty member evaluation and feedback on sign-out using a structured sign-out evaluation tool. Later in the week, written sign-out was independently scored by 2-blinded senior resident reviewers who compared the inclusion of sign-out content, organization, and readability. Results: Compared to baseline data in 128 written sign-outs, the pairing of a 1-page curriculum with weekly faculty member evaluation of written sign-out improved the inclusion of advanced directives from 38% to 69% (p < .001) and anticipatory guidance from a mean score of 1.8 (SD = 1.2) to 2.3 (SD = 1.5) on a 5-point scale ( p = .01) in 177 written sign-outs. Readability and organization were unchanged. Conclusions: A simple curriculum paired with structured faculty evaluation and feedback can improve some parameters of sign-out. Structured evaluative sign-out tools may be useful to improve and teach sign-out skills. [ABSTRACT FROM AUTHOR]

Disclosing errors to patients is an advanced communication skill necessary in clinical practice but traditionally not taught during residency training. We developed an educational seminar for senior residents utilizing didactic, small group discussion, and role play that incorporates principles of error disclosure. Our objectives were to improve resident's knowledge of the key components of disclosing medical errors to patients and to provide opportunity to practice communicating medical error in a safe environment. We assessed whether residents are participating in error disclosure and compared self-rated preparedness to disclose an error before and after the teaching session. Nearly all residents (94%) reported that learning about disclosure of medical errors is a very important part of residency training and 58% of residents had already participated in a disclosure discussion. Residents reported they were significantly more prepared to disclose medical errors to patients after participating in the curriculum compared with before, both in terms of the components of medical error disclosure and the emotional aspects of disclosure. This curriculum was associated with improvement in comfort level with error disclosure. Error disclosure represents an ideal educational opportunity for residencies to address multiple core competencies including patient care, communication skills, and professionalism. [ABSTRACT FROM AUTHOR]

Background/Objectives: To date, research on substance abuse prevention relied extensively on large sample randomized clinical trials to evaluate intervention programs. These designs are appropriate for certain types of randomized prevention trials (e.g., efficacy or effectiveness for broad populations) but are unfeasible for other prevention science scenarios (e.g., rare pathologies, pilot studies, or replication tests at specific locales). Methods: An alternative randomized clinical trial is described that relies on much smaller samples, less resources than the large sample designs, randomization, N-of-1 designs for the intervention group, and mixed model analysis. Results: This methodology is illustrated using a small sample prevention study, which demonstrates its statistical power, flexibility, and sophistication for experimental testing of prevention-oriented research questions. Scientific Significance: This methodology can be applied to many existing prevention datasets to facilitate secondary analyses of existing datasets as well as novel studies. It is hoped that such efforts will include further development of the small sample design in substance abuse prevention contexts. [ABSTRACT FROM AUTHOR]

Background: We sought to determine whether a Web-based curriculum could improve internal medicine residents' perceived preparedness and knowledge in the areas of preconception care, infertility evaluation, and management of medical conditions during pregnancy. Training in these areas has been previously identified as inadequate. Description: Three Web-based modules were developed to teach these topics. Seventy residents at one institution were invited to complete the modules and to participate in the curriculum's evaluation over 6 months. Evaluation: Paper questionnaires assessed preparedness and comfort level among all participants. Web-based surveys that assessed pre/postknowledge and satisfaction among module completers accompanied each module. Ninety-seven percent completed paper questionnaires, and 59% completed 1 or more modules. At the end of the study period, module completers felt significantly more prepared than noncompleters, and improvement in comfort level was strongly associated with the number of modules completed. Knowledge improved significantly with module completion and curricular satisfaction was high. Conclusions: A Web-based approach to teaching these topics to internal medicine residents increased knowledge and perceived preparedness and was well received. [ABSTRACT FROM AUTHOR]