Military medicine
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A medical records review to compare efficiency and effectiveness of a physical therapist (PT) functioning as a musculoskeletal primary care provider (PCP) compared to family practice (FP) physicians functioning as musculoskeletal PCP. ⋯ Using PT as the musculoskeletal PCP was shown to be an effective and efficient practice model to assess and treat patients with musculoskeletal complaints.
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With the advent of simulation technology, several types of data acquisition methods have been used to capture hands-on clinical performance. Motion sensors, pressure sensors, and tool-tip interaction software are a few of the broad categories of approaches that have been used in simulation-based assessments. The purpose of this article is to present a focused review of 3 sensor-enabled simulations that are currently being used for patient-centered assessments of clinical palpation skills. ⋯ The second part provides a detailed discussion regarding validity evidence and implications using the Standards for Educational and Psychological Testing as an organizational and evaluative framework. Special considerations are given to content domain and creation of clinical scenarios from a developer's perspective. The broader relationship of this work to the science of touch is also considered.
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Observational Study
Prevalence of prehospital hypoxemia and oxygen use in trauma patients.
This study estimates the prevalence of injured patients requiring prehospital supplemental oxygen based on existing recommendations, and determines whether actual use exceeds those recommendations. ⋯ On the basis of current guidelines, less than half of adult trauma patients have an indication for prehospital supplemental oxygen, yet is frequently administered in the absence of clinical indication.
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Recent advances in the learning sciences offer remarkable potential to improve medical education and maximize the benefits of emerging medical technologies. This article describes 2 major innovation areas in the learning sciences that apply to simulation and other aspects of medical learning: Perceptual learning (PL) and adaptive learning technologies. PL technology offers, for the first time, systematic, computer-based methods for teaching pattern recognition, structural intuition, transfer, and fluency. ⋯ The author describes the Adaptive Response-Time-based Sequencing (ARTS) system, which uses each learner's accuracy and speed in interactive learning to guide spacing, sequencing, and mastery. In recent efforts, these new technologies have been applied in medical learning contexts, including adaptive learning modules for initial medical diagnosis and perceptual/adaptive learning modules (PALMs) in dermatology, histology, and radiology. Results of all these efforts indicate the remarkable potential of perceptual and adaptive learning technologies, individually and in combination, to improve learning in a variety of medical domains.
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Use of simulation-based assessments and training has become increasingly widespread in medicine. It is recognized that simulations can yield a wealth of real-time information about the trainee or examinee's performance, from which inferences about proficiency can potentially be drawn. However, for the inferences to be useful, psychometric evaluation should be conducted and validity evidence amassed. ⋯ In this article, it is argued that modern psychometric models that are dynamic, multidimensional, and based on latent variables may be useful for evaluating medical simulations. It is also argued that modern computational methods based on Bayesian statistics may provide the technical foundation. Several examples are given and issues for further research are discussed.