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medical training

(Kenny Louie/Flickr)

National data suggest that up to 70 percent of sentinel events—the most serious errors in hospitals—stem at least in part from miscommunications. Communication problems are especially apt to occur during hospital shift changes, when a patient’s care is transferred to incoming doctors and nurses—known in health care as the “handoff.”

More than a year ago, a team led by Amy Starmer, MD, MPH, of the Division of General Pediatrics at Boston Children’s Hospital, developed and began testing a bundle of interventions to ensure that the hospital’s residents were thoroughly and accurately briefed on each patient’s medical history, status and treatment plan in a standardized way.

Through measures such as communications training, a mnemonic to help residents remember key information to pass on and a computerized handoff tool that integrated with the patient’s electronic medical record, they managed to move the needle: Medical errors fell by 40 percent—from 32 percent of admissions at baseline to 19 percent of admissions three months after the program started.

But that wasn’t all. Full story »

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[Ed. note: Tune in to the livestream Monday at 9:30 a.m. ET]

Can the inventors of Watson help save sick children in the developing world? A “cloud-based” pediatric learning module, conceived by Children’s Hospital Boston and built by IBM Interactive, is being beta-tested this year in 20 countries. Provisionally called OpenPediatrics, it will give 1,000 doctors and nurses on five continents the next best thing to hands-on training. (Above is just a preview). Full story »

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Hiep Nguyen (L) and two of his Kenyan colleagues during one of the 41 procedures they performed together in five days. (Photo: Kelly Kristof and Hiep Nguyen)

For over a decade, Hiep Nguyen, MD, FAAP has been traveling the world as part of a nonprofit surgical and education team, dedicated to improving pediatric urology in developing countries. Nguyen’s recent experiences leading a surgical team in Kenya highlighted the need for a better way to keep his international colleagues up to date on the rapidly evolving field of pediatric urologic surgery.

Once a year, I lead a group of dedicated volunteers from International Volunteers in Urology (or IVUmed) to a remote part of the world to help train local physicians to care for children with urological problems, in particular congenital anomalies of the genitourinary tract. Despite these conditions being common – they affect between two and 15 percent of all children – very few physicians are specifically trained to take care of children who have them. The ways in which we diagnose and care for congenital urological problems are evolving rapidly and, consequently, such care is increasingly delivered by full-time specialists – specialists who are often in limited supply, especially outside of the United States.

On a trip to Kenya last month, our IVUmed team, assisted by the local surgeons, operated on 41 patients in five days. In the process, the physicians there got their first exposure to many aspects of diagnosing and managing congenital genitourinary malformations. They soaked up the knowledge with enthusiasm and demanded more, but unfortunately, our time there was limited, and it will be another year before we return and resume their education.

Despite the success of these trips, I always sense that we could do a better job if we could work with our colleagues overseas more consistently and expose them more constantly to the urologic techniques and concepts we teach. But it is impossible to be there with them every day.

Or is it? Full story »

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This post, final of a three-part series, is adapted from a talk by Jeffrey P. Burns, MD, MPH, Chief of the Division of Critical Care Medicine at Children’s Hospital Boston, at the IBM Impact 2011 Global Conference. (See posts one and two.)

We have a healthcare gap in the United States and around the globe: There aren’t enough doctors and nurses trained in how to take care of a critically ill child. Children are not little adults; you can’t just cut the doses.

So we need a solution. But the solution that we need in a resource-limited environment is not the same solution that we need in a resource-advantaged environment. We need to find a platform that addresses the needs of both.

Several years ago, one of my colleagues, Traci Wolbrink, went to a camp in sub-Saharan Africa, Full story »

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Jeffrey P. Burns, MD, MPH, is Chief of the Division of Critical Care Medicine at Children’s Hospital Boston. He established and is Executive Director of the Children’s Hospital Simulator Program, one of the first hospital-based pediatric simulator programs in the U.S., and also co-chairs the hospital’s Ethics Committee. This post, second of three parts, is adapted from his recent talk at the IBM Impact 2011 Global Conference.

“Practice makes perfect” is an axiom that holds for most tasks, including providing health care to a critically ill patient.  And yet even if I’m in training for several years, the experiences I get and the experiences the person next to me gets are radically different – in fact, they’re very random.  I’m on one night, you’re on the next night, and what I saw last night, you won’t see tonight.

That’s no way to dose and sequence knowledge; in fact, no one would set up an educational program where you learned randomly.  There’s a troublesome paradox: Medical crises are relatively rare events in children, as compared with adults, and thus there are fewer physicians and nurses with the necessary experience in caring for critically ill children.

Every month, I get letters from all over the world – “Dr. Burns, can I observe in your ICU?” Last month, we’ve had somebody from Iran, Pakistan and Turkey. And yet we often must say “no,” because the walls are only so big. How can we best spread our knowledge and expertise? Full story »

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(This post, the first of three, is adapted from a talk Jeffrey Burns, MD, MPH, gave at IBM’s Impact 2011 Global Conference in April. For the full talk, jump to 44:37 in this video.)

Right now, valuable information is bottlenecked in an old paradigm. Expert training on how to treat children with life-threatening illnesses is available at relatively few hospitals across the world, and access to this training remains anchored to an apprenticeship model – see one, do one, teach one – that’s now nearly 100 years old.

We need to change that paradigm. Full story »

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