journal article Open Access Mar 03, 2023

Under- and post-graduate training to manage the acutely unwell patient: a scoping review

View at Publisher Save 10.1186/s12909-023-04119-1
Abstract
AbstractBackgroundJunior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach.MethodsThe review, informed by the Arksey and O’Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022.ResultsSeventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study.ConclusionsThe results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.
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References
108
[1]
Smith C, Perkins G, Bullock I, Bion J. Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med. 2007;33(5):901–7. 10.1007/s00134-007-0564-8
[2]
Tallentire VR, Smith SE, Wylde K, Cameron HS. Are medical graduates ready to face the challenges of foundation training? Postgrad Med J. 2011;87(1031):590–5. 10.1136/pgmj.2010.115659
[3]
Miles S, Kellett J, Leinster S. Medical graduates preparedness to practice: a comparison of undergraduate medical school training. BMC Med Educ. 2017;17(1):33. 10.1186/s12909-017-0859-6
[4]
Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE, et al. New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study. BMJ Open. 2018;8(8):e023146. 10.1136/bmjopen-2018-023146
[5]
Baker BG, Bhalla A, Doleman B, Yarnold E, Simons S, Lund JN, et al. Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment. Med Teach. 2017;39(1):53–7. 10.1080/0142159x.2016.1230188
[6]
Lefroy J, Yardley S, Kinston R, Gay S, McBain S, McKinley R. Qualitative research using realist evaluation to explain preparedness for doctors’ memorable ‘firsts’. Med Educ. 2017;51(10):1037–48. 10.1111/medu.13370
[7]
Kilminster S, Zukas M, Quinton N, Roberts T. Preparedness is not enough: understanding transitions as critically intensive learning periods. Med Educ. 2011;45(10):1006–15. 10.1111/j.1365-2923.2011.04048.x
[8]
Bion JF, Heffner JE. Challenges in the care of the acutely ill. Lancet. 2004;363(9413):970–7. 10.1016/s0140-6736(04)15793-0
[9]
Massey D, Aitken LM, Chaboyer W. What factors influence suboptimal ward care in the acutely ill ward patient? Intensive Crit Care Nurs. 2009;25(4):169–80. 10.1016/j.iccn.2009.03.005
[10]
Scoping studies: towards a methodological framework

Hilary Arksey, Lisa O'Malley

International Journal of Social Research Methodolo... 2005 10.1080/1364557032000119616
[11]
Armstrong R, Hall BJ, Doyle J, Waters E. ‘Scoping the scope’of a cochrane review. J Public Health. 2011;33(1):147–50. 10.1093/pubmed/fdr015
[12]
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

David Moher, Alessandro Liberati, Jennifer Tetzlaff et al.

Annals of Internal Medicine 2009 10.7326/0003-4819-151-4-200908180-00135
[13]
Walsh CM, Fung M, Ginsburg S. Publication of results of abstracts presented at medical education conferences. JAMA. 2013;310(21):2307–9. 10.1001/jama.2013.281671
[14]
Improving the Reporting Quality of Nonrandomized Evaluations of Behavioral and Public Health Interventions: The TREND Statement

Don C. Des Jarlais, Cynthia Lyles, Nicole Crepaz

American Journal of Public Health 2004 10.2105/ajph.94.3.361
[15]
Cook DA, Bordage G, Schmidt HG. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Med Educ. 2008;42(2):128–33. 10.1111/j.1365-2923.2007.02974.x
[16]
Abdeldaim Y, Khalil MM, Wagih K, Galal IH, Salem HM, Elbeialy M. Development and implementation of a simulation training program for acute respiratory-failure management in the pulmonary intensive care unit. Egypt J Chest Dis Tuberc. 2021;70(4):534–40. 10.4103/ecdt.ecdt_43_21
[17]
AbdelFattah KR, Spalding MC, Leshikar D, Gardner AK. Team-based simulations for new surgeons: does early and often make a difference? Surgery. 2018;163(4):912–5. 10.1016/j.surg.2017.11.005
[18]
Alsaad AA, Davuluri S, Bhide VY, Lannen AM, Maniaci MJ. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training. Adv Med Educ Pract. 2017;8:481. 10.2147/amep.s134235
[19]
Arora S, Hull L, Fitzpatrick M, Sevdalis N, Birnbach DJ. Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills. Ann Surg. 2015;261(5):888–93. 10.1097/sla.0000000000000824
[20]
Beane A, Padeniya A, De Silva A, Stephens T, De Alwis S, Mahipala P, et al. Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice. Postgrad Med J. 2017;93(1104):592–6. 10.1136/postgradmedj-2016-134718
[21]
Beckers S, Fries M, Bickenbach J, Hoffmann N, Classen-Linke I, Killersreiter B, et al. Evaluation of a new approach to implement structured, evidence-based emergency medical care in undergraduate medical education in Germany. Resuscitation. 2005;65(3):345–56. 10.1016/j.resuscitation.2004.11.023
[22]
Binstadt ES, Walls RM, White BA, Nadel ES, Takayesu JK, Barker TD, et al. A comprehensive medical simulation education curriculum for emergency medicine residents. Ann Emerg Med. 2007;49(4):495–504 e11. 10.1016/j.annemergmed.2006.08.023
[23]
Bongers KS, Heidemann LA. Cross-cover curriculum for senior medical students. MedEdPORTAL. 2020;16:10944. 10.15766/mep_2374-8265.10944
[24]
Brailovsky Y, Kunchakarra S, Lakhter V, Barnes G, Masic D, Mancl E, et al. Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty. J Thromb Thrombolysis. 2020;49(1):54–8. 10.1007/s11239-019-01927-5
[25]
Brunt LM, Halpin VJ, Klingensmith ME, Tiemann D, Matthews BD, Spitler JA, et al. Accelerated skills preparation and assessment for senior medical students entering surgical internship. J Am Coll Surg. 2008;206(5):897–904. 10.1016/j.jamcollsurg.2007.12.018
[26]
Byrne-Davis L, Slattery H, Whiteside S, Moro E, Jackson M, Onyachi N, et al. Efficacy and acceptability of an acute illness management course delivered to staff and students in Uganda by staff from the UK. Int Health. 2015;7(5):360–6. 10.1093/inthealth/ihu078
[27]
Cachia M, Pace-Bardon M, Balzan G, Tilney R, Micallef J, Balzan M. Simulation training for foundation doctors on the management of the acutely ill patient. Adv Med Educ Pract. 2015;6:657. 10.2147/amep.s96566
[28]
Carling J. Are graduate doctors adequately prepared to manage acutely unwell patients? Clin Teach. 2010;7(2):102–5. 10.1111/j.1743-498x.2010.00341.x
[29]
Carter MB, Wesley G, Larson GM. Didactic lecture versus instructional standardized patient interaction in the surgical clerkship. Am J Surg. 2005;189(2):243–8. 10.1016/j.amjsurg.2004.09.013
[30]
Cash T, Brand E, Wong E, Richardson J, Athorn S, Chowdhury F. Near-peer medical student simulation training. Clin Teach. 2017;14(3):175–9. 10.1111/tct.12558
[31]
Cetrone E, Rozansky H, Ramani S. Training junior doctors to lead rapid responses. Clin Teach. 2021;18(6):650–5. 10.1111/tct.13426
[32]
Christensen MD, Rieger K, Tan S, Dieckmann P, Østergaard D, Watterson LM. Remotely versus locally facilitated simulation-based training in management of the deteriorating patient by newly graduated health professionals: a controlled trial. Simul Healthc. 2015;10(6):352–9. 10.1097/sih.0000000000000123
[33]
Church HR, Murdoch-Eaton D, Sandars J. Using insights from sports psychology to improve recently qualified Doctors’ self-efficacy while managing acutely unwell patients. Acad Med. 2021;96(5):695–700. 10.1097/acm.0000000000003809
[34]
Dave MS, Mobarak S, HVM S, Tarazi M, Jamdar S. Improving knowledge and confidence in foundation doctors during specialty changeover; 2020. 10.1093/intqhc/mzaa070
[35]
DeWaay DJ, McEvoy MD, Alexander LA, Kern DH, Nietert PJ. Simulation curriculum can improve medical student assessment and Management of Acute Coronary Syndrome during a clinical practice exam. Am J Med Sci. 2014;347(6):452–6. 10.1097/maj.0b013e3182a562d7
[36]
Drost-de Klerck AM, Olgers TJ, van de Meeberg EK, Schonrock-Adema J, Ter Maaten JC. Use of simulation training to teach the ABCDE primary assessment: an observational study in a Dutch University hospital with a 3-4 months follow-up. BMJ Open. 2020;10(7):e032023. 10.1136/bmjopen-2019-032023
[37]
Dworetzky BA, Peyre S, Bubrick EJ, Milligan TA, Yule SJ, Doucette H, et al. Interprofessional simulation to improve safety in the epilepsy monitoring unit. Epilepsy Behav. 2015;45:229–33. 10.1016/j.yebeh.2015.01.018
[38]
Fuhrmann L, Ostergaard D, Lippert A, Perner A. A multi-professional full-scale simulation course in the recognition and management of deteriorating hospital patients. Resuscitation. 2009;80(6):669–73. 10.1016/j.resuscitation.2009.03.013
[39]
Gallagher K, Blackwell N, Thomas B, Trail M, Stewart L, Paterson R. Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital. BMJ Open Qual. 2019;8(2):e000369. 10.1136/bmjoq-2018-000369
[40]
Gruber PC, Gomersall CD, Joynt GM, Shields FM, Chu MC, Derrick JL. Teaching acute care: a course for undergraduates. Resuscitation. 2007;74(1):142–9. 10.1016/j.resuscitation.2006.11.021
[41]
Herbstreit F, Merse S, Schnell R, Noack M, Dirkmann D, Besuch A, et al. Impact of standardized patients on the training of medical students to manage emergencies. Medicine. 2017;96(5):e5933. 10.1097/md.0000000000005933
[42]
Jeimy S, Wang JY, Richardson L. Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study. BMC Res Notes. 2018;11(1):357. 10.1186/s13104-018-3463-x
[43]
Kulshreshtha P, Bahurupi Y, Dhar M, Sharma S, Kathrotia R, Rao S, et al. Preparedness of undergraduate medical students to combat COVID-19: a tertiary care experience on the effectiveness and efficiency of a training program and future prospects. Cureus J Med Sci. 2022;14(3):e22971.
[44]
Kwan B, Bui G, Jain P, Shah N, Juang D. Exploring simulation in the internal medicine clerkship. Clin Teach. 2017;14(5):349–54. 10.1111/tct.12577
[45]
Lammers RL, Sheakley ML, Hendren S. A simulated case of acute salicylate toxicity from an intentional overdose; 2018. 10.15766/mep_2374-8265.10678
[46]
Lovell B, Etomi O, Krishnamoorthy S, Murch N. Simulation training for acute medical specialist trainees: a pilot. Acute Med. 2013;12(2):77–82. 10.52964/amja.0291
[47]
MacDowall J. The assessment and treatment of the acutely ill patient--the role of the patient simulator as a teaching tool in the undergraduate programme. Med Teach. 2006;28(4):326–9. 10.1080/01421590600625130
[48]
MacEwen A, Carty D, McConnachie A, McKay G, Boyle J. A “diabetes acute care day” for medical students increases their knowledge and confidence of diabetes care: a pilot study. BMC Med Educ. 2016;16(1):88. 10.1186/s12909-016-0600-x
[49]
Maddry JK, Varney SM, Sessions D, Heard K, Thaxton RE, Ganem VJ, et al. A comparison of simulation-based education versus lecture-based instruction for toxicology training in emergency medicine residents. J Med Toxicol. 2014;10(4):364–8. 10.1007/s13181-014-0401-8
[50]
Mallik R, Patel M, Atkinson B, Kar P. Exploring the role of virtual reality to support clinical diabetes training-a pilot study; 2022. 10.1177/19322968211027847

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Mar 03, 2023
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Helen R. Church, Deborah Murdoch-Eaton, John Sandars (2023). Under- and post-graduate training to manage the acutely unwell patient: a scoping review. BMC Medical Education, 23(1). https://doi.org/10.1186/s12909-023-04119-1