The Yale journal of biology and medicine
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Purpose: Point of care ultrasound (POCUS) brings high-quality patient care to the bedside but continues to be an expensive training to implement in a residency program. There are multiple resources available to train providers in ultrasound, but they are all associated with significant cost. The Accreditation Council for Graduate Medical Education (ACGME) mandates anesthesiology residents to be competent in diagnostic and therapeutic uses of ultrasound. ⋯ Having residents go through the simulator decreased the time that faculty would otherwise have spent going over basics with the students while allowing students to master these skills at their own pace. Advances in ultrasound technology have created newer, more affordable machines which can decrease cost considerably. It would serve departments well to consider alternatives and plan for resources when deciding to implement POCUS curriculum for resident training.
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Background: Medical education is evolving to incorporate learner-centered strategies which encourage student engagement. Educators need to ensure that meaningful education occurs within limited interaction time between teachers and trainees. The Flipped Classroom (FC) model combines the use of both online and face-to-face interaction. ⋯ Conclusions: Residency programs need to adopt evidence-based solutions to problems arising in medical education. We present our experiences in finding a solution to make didactic sessions more engaging. Our initial assessment shows that it is feasible to introduce the FC model into an existing curriculum in an anesthesia residency program and both residents and faculty felt that the format enhanced learning and interaction in class.
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Background: Competency-based assessment is an important but challenging aspect of residency education but determines trainees' progression towards the ultimate goal of graduation. Entrustment decision making has been proposed as a supplementary metric to assess trainee competence. This study explores the process by which Program Directors (PDs) make entrustment decisions in Internal Medicine (IM) training programs. ⋯ Conclusions: PDs serve as a central processor by which assessment data on trainees is filtered, weighted, and compared an expected trajectory, all to gain understanding of trainee performance. Assessment networks are crucial to understanding trainee competence. While expected trajectory is an important tool to determine how trainees are progressing, its continued use may inject bias into the assessment process and slow transition to true competency-based assessment.
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Objective: Scientific research on how consumption of whole, natural Cannabis flower affects low mood and behavioral motivations more generally is largely nonexistent, and few studies to date have measured how common and commercially available Cannabis flower used in vivo may affect the experience of "depression" in real-time. Methods: We observed 1,819 people who completed 5,876 cannabis self-administration sessions using the ReleafApp™ between 06/07/2016 and 07/08/2019, with the goal of measuring real-time effects of consuming Cannabis flower for treating symptoms of depression. Results: On average, 95.8% of users experienced symptom relief following consumption with an average symptom intensity reduction of -3.76 points on a 0-10 visual analogue scale (SD = 2.64, d = 1.71, p <.001). ⋯ Across cannabinoid levels, tetrahydrocannabinol (THC) levels were the strongest independent predictors of symptom relief, while cannabidiol (CBD) levels, instead, were generally unrelated to real-time changes in symptom intensity levels. Cannabis use was associated with some negative side effects that correspond to increased depression (e.g. feeling unmotivated) in up to 20% of users, as well as positive side effects that correspond to decreased depression (e.g. feeling happy, optimistic, peaceful, or relaxed) in up to 64% of users. Conclusions: The findings suggest that, at least in the short term, the vast majority of patients that use cannabis experience antidepressant effects, although the magnitude of the effect and extent of side effect experiences vary with chemotypic properties of the plant.
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Background: American College of Emergency Physicians (ACEP) [1] recommends that patients presenting with acute non-traumatic headache concerning for subarachnoid hemorrhage (SAH) undergo lumbar puncture (LP) when non-contrast head computed tomography (CT) is negative. The diagnostic yield of this approach is unknown. Objective: Evaluate the diagnostic yield, lengths of stay and complication rates of LPs in patients undergoing Emergency Department (ED) evaluation for aneurysmal SAH. ⋯ Total length of stay was 7.8 hours (0.95 CI; 7.5 - 8.2). No patient discharged from the ED after a negative workup for SAH was re-admitted for SAH or underwent a neurosurgical procedure during a three-month follow-up period. Conclusions: LP in our cohort of neurologically intact CT-negative ED headache patients did not identify any cases of aneurysmal SAH but was associated with serious complications, a significant false positive rate, and extended ED length of stay.