Education methods aimed at improving patient safety, specifically patient-centered simulation training, was another hot topic in 2014 medical literature, Dr. Hoellein said. Mayo Clinic education researcher David A. Cook, MD, published a meta-analysis of 592 studies on patient-centered simulation training in medical education and found an overabundance of evidence to support its use.2
“Clearly, we have an excess of evidence on this topic,” said Dr. Hoellein. Some authors may be unaware of existing studies, or they may wish to publish their own findings. “Some replication is necessary, but at some point, it may no longer be needed. We need to recognize what’s been happening in the past, but we need to stop wasting time and dollars on unimportant research questions or on those already answered.”
Hospitalist services at teaching hospitals was another common topic among published medical education articles in 2014, said Dr. Hoellein. One study published in the Journal of General Internal Medicine compared three different types of hospitalist services at academic medical centers: hospitalists, hospitalist-preceptors and academician-preceptors.3 Having a hospitalist alone translated to the lowest readmission rate of the three but higher cumulative costs. Centers with a hospitalist-preceptor recorded the shortest length of stays for patients and may be the best approach for teaching hospitals, Dr. Hoellein said.
Patient care transition, or handovers of cases, is an important time for ensuring patient safety, said Dr. Hoellein. Studies analyzing handovers were a popular topic in 2014’s medical education literature, including methods for effectively conducting handovers from overnight to morning staff reduce omission of clinically relevant issues.
“I think morning is the most hectic, chaotic time for handover,” Dr. Hoellein noted. In an article published in the Journal of the American Medical Association Internal Medicine, Canadian researchers analyzed morning handover practices at two Toronto academic medical centers.4 They concluded that providing a dedicated time and distraction-free setting, such as a conference room rather than a crowded hallway, would reduce omissions by on-call trainees during handovers, he said.
Competency Influencers
Knowledge of musculoskeletal anatomy is lacking among rheumatologists and rheumatology fellows, affecting diagnostic competency, according to an article published in Arthritis Care & Research in 2014.5
When 170 participants in rheumatology workshops completed practical anatomy tests, rheumatology fellows scored the highest, perhaps due to musculoskeletal ultrasound training. Older, more experienced rheumatologists also did well, said Dr. Hoellein. “However, musculoskeletal knowledge is still suboptimal, especially of the hand,” he noted. Better foundation of anatomy knowledge may also save costs over the long term, he said. “A physical exam is still the cheapest lab test.”
