BackgroundThe emotional consequences of patient deaths on physicians have been studied in a variety of medical settings. Reactions to patient death include distress, guilt, and grief. Comparatively, there are few studies on the effects of patient death on physicians and residents in the Emergency Department (ED). The ED setting is considered unique for having more sudden deaths that likely include the young and previously healthy and expectations for the clinician to return to a dynamic work environment. To date, no studies have looked at the effects of patient deaths on the more vulnerable population of medical students in the ED. This study examined aspects of patient deaths in the ED that most strongly influence students’ reactions while comparing it to those of an inpatient setting.MethodsSemi-structured qualitative interviews were carried out with a total of 16 medical students from the American University of Beirut, Medical Center in Lebanon who had recently encountered a patient death in the ED. Questions included their reaction to the death, interaction with patients and their family members, the response of the medical team, and coping mechanisms adopted.ResultsThe analysis revealed the following as determinant factors of student reaction to patient death: context of death; including age of patient, expectation of death, first death experience, relating patient death to personal deaths, and extent of interaction with patient and family members. Importantly, deaths in an inpatient setting were judged as more impactful than ED deaths. ED deaths, however, were especially powerful when a trauma case was deemed physically disturbing and cases in which family reactions were emotionally moving.ConclusionThe study demonstrates that students’ emotional reactions differ as a function of the setting (surprise and shock in the ED versus sadness and grief in an inpatient setting). Debriefing and counseling sessions on ED deaths may benefit from this distinction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0945-9) contains supplementary material, which is available to authorized users.

IntroductionMedication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%–38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.MethodsWe conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.ResultsOverall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).ConclusionA basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

BackgroundMeasuring milestones, competencies, and sub-competencies as residents progress through a training program is an essential strategy in Accreditation Council for Graduate Medical Education (ACGME)’s attempts to ensure graduates meet expected professional standards. Previous studies have found, however, that physicians make global ratings often by using a single criterion.MethodsWe use advanced statistical analysis to extend these studies by examining the validity of ACGME International competency measures for an international setting, across emergency medicine (EM) and neurology, and across evaluators. Confirmatory factor analysis (CFA) models were fitted to both EM and neurology data. A single-factor CFA was hypothesized to fit each dataset. This model was modified based on model fit indices. Differences in how different EM physicians perceived the core competencies were tested using a series of measurement invariance tests.ResultsExtremely high alpha reliability coefficients, factor coefficients (> .93), and item correlations indicated multicollinearity, that is, most items being evaluated could essentially replace the underlying construct itself. This was true for both EM and neurology data, as well as all six EM faculty.ConclusionsEvaluation forms measuring the six core ACGME competencies did not possess adequate validity. Severe multicollinearity exists for the six competencies in this study. ACGME is introducing milestones with 24 sub-competencies. Attempting to measure these as discrete elements, without recognizing the inherent weaknesses in the tools used will likely serve to exacerbate an already flawed strategy. Physicians likely use their “gut feelings” to judge a resident’s overall performance. A better process could be conceived in which this subjectivity is acknowledged, contributing to more meaningful evaluation and feedback.

Several models have been proposed to conceptualize worry. Broadly, the models can be classified as cognitive (including the Avoidance Model, the Intolerance of Uncertainty Model, and the Metacognitive Model) and emotion-focused (including Emotion Dysregulation and Acceptance-Based models). Although these models have received strong empirical investigation in primarily non-Hispanic White samples, no known study has examined the applicability to racial and ethnic minority groups. The current study compared the proportion of variance explained by cognitive and emotion-focused models of worry in White and Black samples. Results indicated that cognitive and emotion-focused models significantly predicted worry in both Black and White samples. However, the overall amount of variance in worry explained by the models was less for Black samples. Specifically, controlling for gender, the cognitive models explained 53% of the variance in worry in the White sample compared with 19% in the Black sample. Similarly, the emotion-focused models explained 34% of the variance in worry in the White sample but only 13% in the Black sample. These findings suggest that well-established conceptual frameworks for worry failed to explain the bulk of the variance in worry in Black samples, leaving much unknown. Additional research is needed to identify key variables that may further explain worry in ethnic minority samples.

SummaryThe effect of religious priming has been studied in relation to a number of variables, most extensively with prosocial behavior. The effects of priming on cognitive domains, however, are relatively understudied. The present study examined the effects of religious priming, compared with reflective and neutral priming, on the conjunction fallacy. Participants were randomly assigned to 1 of the 3 priming conditions. Priming was presented through the scrambled sentence task in which participants were required to rearrange words of a religious (e.g., pray), reflective (e.g., reason), or neutral (e.g., paper) content. The conjunction fallacy was measured by a task containing 1 problem. Results indicated that those undergoing the religious prime were significantly more likely to commit the conjunction fallacy compared with those in the reflective priming group. Situations in which reasoning is integral may benefit from knowing the immediate effects of religious versus reflective stimuli in the environment.