Presented at the 19th General Scientific Meeting of Anesthesiologists 2011
Title: Medical Student-driven Patient Safety Education with Human Simulator
M4 Students: Steffi Chan, Jonathan Cheng, Matthew Low, Tay Jun Yang
NUHS Faculty: Dr Terry Pan, A/Prof Ti Lian Kah, A/Prof Sophia Ang
Small group teaching with the human patient simulator is effective in teaching patient safety concepts to medical students, but requires considerable teaching hours. Peer-teaching may reduce faculty time requirement. Furthermore, engagement of students in teaching improves their learning experience 1,2 We hypothesize that students undergoing a peer-teaching program will improve their grasp of patient safety concepts.
Four student-trainers designed the peer-teaching program using the existing faculty-taught patient safety course for medical students. 45 medical students attended the program. After completing their pre-session reading requirements, students were divided into teams (mean of 4 students) to manage two standardized simulated scenarios. Debriefings were done by the student-trainers after each scenario. Ten best-of-four-options knowledge questions and four 5-point likert-scale survey questions were given immediately before and after the program. Students were also surveyed on their learning experience. Data was analyzed with SPSS.
The students’ knowledge scores did not change (p = 0.943). However, students felt more confident (increase of 1.5 points, p<0.05) in handing scenarios. Most participants felt that the session was useful (98%), would recommend to a colleague (98%) and wanted it included in their official curriculum. Students felt more aware of patient safety issues (96%), and found peer-teaching to be an effective (96%) and enjoyable way of learning (98%).
Despite similar knowledge scores, students enjoyed the learning session and grew more confident in handling patient safety scenarios. We recommend that peer-teaching be encouraged in medical-school curriculum, making learning interactive and building confidence without compromising theoretical knowledge.
Link to Poster Presentation
Title: Fears that preoperative patients have of general anaesthesia
M4 Students: Elizabeth Ng, Sia Ching Hui
NUHS Faculty: Dr Ahilan Pathmanathan, A/Prof Liu Hern Choon, Eugene
Introduction: A large proportion of patients experience substantial anxiety before surgery. Pre-operative anxiety has been found to be a predictor of post-operative pain and the need for post-operative analgesia. It is also associated with decreased patient satisfaction with peri-operative care and reduces the quality of recovery. This study aimed to identify common pre-operative fears and concerns about general anaesthesia (GA) which may result in increased anxiety, to improve care of patients undergoing GA.
Methods: A cross-sectional study was conducted. Participants were patients visiting the Anaesthetic Outpatient Consultation Clinic (AOCC) at National University Hospital, Singapore, over a period of 3 months. An interviewer-administered questionnaire elicited the fears and anxieties of pre-operative patients with regards to general anaesthesia. The data was analysed using SPSS Version 18.0.
Results: The response rate was 98.3% (115/117). 43.6% were males, 56.4% were females, and they were between 21-86 years old. 68.4% revealed that they were anxious about the upcoming GA. Women and patients with lower educational levels had higher rates of anxiety. The commonest fears were post-operative pain (69.8% of respondents), failing to wake up (68.4%), having tubes put down one’s airway (61.5%), awareness (55.6%), memory loss after general anaesthesia (51.3%) and brain damage due to general anaesthesia (50.4%). 73.3% of participants indicated that having more knowledge about GA and 81.0% indicated that receiving reassurance from their anaesthetist would help alleviate their anxiety.
Conclusion: Many patients have fears about undergoing general anesthesia. We can target preoperative counseling to allay these specific fears, to reduce preoperative anxiety.
Link to Poster Presentation
Title: Neurological deficits after peripheral nerve blocks - a case control study
M4 Students: Foong Theng Wai
NUHS Faculty: Dr Poon Keah How
Objectives: The primary aim was to determine the incidence of neurological deficits after peripheral nerve blocks performed in a University teaching hospital. The secondary aim was to determine the factors that may be associated with the development of neurological deficits.
Methodology: A case control methodology was employed and data was collected retrospectively from March 2008 to February 2011. Cases were defined as subjects who had neurological deficits 24 hours after a nerve block. Controls were matched to the cases according to type of blocks, gender and age.
Results: 811 brachial plexus blocks and 926 femoral and sciatic blocks were performed during the 3 year period. The mean age of the cases was 38.2 years old; 85% were males. The incidence of neurological deficits for brachial plexus blocks was 4.32% at 24 hours and 1.97% at 72 hours while that for lower limb blocks was 3.02% at 24 hours and 1.08% at 72 hours. Logistic regression analyses did not identify the presence of diabetes mellitus, peripheral vascular disease, history of strokes or non use of ultrasound as independent predictors for neurological deficits after nerve blocks.
Conclusions: The incidence of neurological deficits after brachial plexus blocks was 4.32% and for lower limb blocks was 3.02%. This is comparable to international standards which quoted 3% for neuropathy after peripheral nerve block. We did not find any predictors for the occurrence of neurological deficits after peripheral nerve block in this cohort of patients.
Link to Poster Presentation