IU Indianapolis ScholarWorks :: Browsing by Author "Ahmed, Rami A."

Browsing by Author "Ahmed, Rami A."

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A descriptive study of the multidisciplinary healthcare experiences of inpatient resuscitation events
(Elsevier, 2023-01-06) Varner-Perez, Shelley E.; Shelley E., Kelly A. L.; Banks, Sarah K.; Burke, Emily S.; Slaven, James E.; Morse, Gregory J.; Whitaker, Myra K.; Cottingham, Ann H.; Ahmed, Rami A.; Biostatistics, School of Public Health
Background: In-hospital resuscitation events have complex and enduring effects on clinicians, with implications for job satisfaction, performance, and burnout. Ethically ambiguous cases are associated with increased moral distress. We aim to quantitatively describe the multidisciplinary resuscitation experience. Methods: Multidisciplinary in-hospital healthcare professionals at an adult academic health center in the Midwestern United States completed surveys one and six weeks after a resuscitation event. Surveys included demographic data, task load (NASA-TLX), overall and moral distress, anxiety, depression, and spiritual peace. Spearman's rank correlation was computed to assess task load and distress. Results: During the 5-month study period, the study included 12 resuscitation events across six inpatient units. Of 82 in-hospital healthcare professionals eligible for recruitment, 44 (53.7%) completed the one-week post-resuscitation event survey. Of those, 37 (84.1%) completed the six-week survey. Highest median task load burden at one week was seen for temporal demand, effort, and mental demand. Median moral distress scores were low, while "at peace" median scores tended to be high. There were no significant non-zero changes in task load or distress scores from weeks 1-6. Mental demand (r = 0.545, p < 0.001), physical demand (r = 0.464, p = 0.005), performance (r = -0.539, p < 0.001), and frustration (r = 0.545, p < 0.001) significantly correlated with overall distress. Performance (r = -0.371, p = 0.028) and frustration (r = 0.480, p = 0.004) also significantly correlated with moral distress. Conclusions: In-hospital healthcare professionals' experiences of resuscitation events are varied and complex. Aspects of task load burden including mental and physical demand, performance, and frustration contribute to overall and moral distress, deserving greater attention in clinical contexts.
A Simulation-based PPE orientation training curriculum for novice physicians
(Elsevier, 2023) Greaves, Spencer W.; Alter, Scott M.; Ahmed, Rami A.; Hughes, Kate E.; Doos, Devin; Clayton, Lisa M.; Solano, Joshua J.; Echeverri, Sindiana; Shih, Richard D.; Hughes, Patrick G.; Emergency Medicine, School of Medicine
Background: Personal protective equipment (PPE) is effective in preventing coronavirus disease (COVID-19) infection. Resident knowledge of proper use and effective training methods is unknown. We hypothesise that contamination decreases and knowledge increases after a formalised PPE educational session. Methods: Participants included first year interns during their residency orientation in June 2020. Before training, participants took a knowledge test, donned PPE, performed a simulated resuscitation, and doffed. A standardised simulation-based PPE training of the donning and doffing protocol was conducted, and the process repeated. Topical non-toxic highlighter tracing fluid was applied to manikins prior to each simulation. After doffing, areas of contamination, defined as discrete fluorescent areas on participants' body, was evaluated by ultraviolet light. Donning and doffing were video recorded and asynchronously rated by two emergency medicine (EM) physicians using a modified Centers for Disease Control and Prevention (CDC) protocol. The primary outcome was PPE training effectiveness defined by contamination and adherence to CDC sequence. Results: Forty-eight residents participated: 24 internal medicine, 12 general surgery, 6 EM, 3 neurology, and 3 psychiatry. Before training, 81% of residents were contaminated after doffing; 17% were contaminated after training (P<0.001). The most common contamination area was the wrist (50% pre-training vs. 10% post-training, P<0.001). Donning sequence adherence improved (52% vs. 98%, P<0.001), as did doffing (46% vs. 85%, P<0.001). Participant knowledge improved (62%-87%, P <0.001). Participant confidence (P<0.001) and preparedness (P<0.001) regarding using PPE increased with training. Conclusion: A simulation-based training improved resident knowledge and performance using PPE.
Advanced closed-loop communication training: the blindfolded resuscitation
(BMJ, 2019-12-20) Hughes, Kate E.; Hughes, Patrick G.; Cahir, Thomas; Plitt, Jennifer; Ng, Vivienne; Bedrick, Edward; Ahmed, Rami A.; Emergency Medicine, School of Medicine
Closed-loop communication (CLC) improves task efficiency and decreases medical errors; however, limited literature on strategies to improve real-time use exist. The primary objective was whether blindfolding a resuscitation leader was effective to improve crisis resource management (CRM) skills, as measured by increased frequency of CLC. Secondary objectives included whether blindfolding affected overall CRM performance or perceived task load. Participants included emergency medicine (EM) or EM/paediatric dual resident physicians. Participants completed presurveys, were block randomised into intervention (blindfolded) or control groups, lead both adult and paediatric resuscitations and completed postsurveys before debriefing. Video recordings of the simulations were reviewed by simulation fellowship-trained EM physicians and rated using the Ottawa CRM Global Rating Scale (GRS). Frequency of CLC was assessed by one rater via video review. Summary statistics were performed. Intraclass correlation coefficient was calculated. Data were analysed using R program for analysis of variance and regression analysis. There were no significant differences between intervention and control groups in any Ottawa CRM GRS category. Postgraduate year (PGY) significantly impacts all Ottawa GRS categories. Frequency of CLC use significantly increased in the blindfolded group (31.7, 95% CI 29.34 to 34.1) vs the non-blindfolded group (24.6, 95% CI 21.5 to 27.7). Participant's self-rated perceived NASA Task Load Index scores demonstrated no difference between intervention and control groups via a Wilcoxon rank sum test. Blindfolding the resuscitation leader significantly increases frequency of CLC. The blindfold code training exercise is an advanced technique that may increase the use of CLC.
Application of a Simulation-Based Interprofessional Teamwork Assessment Tool (SITAT) to Individual Student Performance in a Team-Based Simulation
(SAGE, 2021-01-01) Daulton, Brittany J.; Romito, Laura; Weber, Zach; Burba, Jennifer; Ahmed, Rami A.; Emergency Medicine, School of Medicine
There are a very limited number of instruments to assess individual performance in simulation-based interprofessional education (IPE). The purpose of this study was to apply the Simulation-Based Interprofessional Teamwork Assessment Tool (SITAT) to the individualized assessment of medicine, pharmacy, and nursing students (N = 94) in a team-based IPE simulation, as well as to explore potential differences between disciplines, and calculate reliability estimates for utilization of the tool. Results of an analysis of variance provided evidence that there was no statistically significant difference among professions on overall competency (F(2, 91) = 0.756, P = .472). The competency reports for nursing (M = 3.06, SD = 0.45), medicine (M = 3.19, SD = 0.42), and pharmacy (M = 3.08, SD = 0.49) students were comparable across professions. Cronbach's alpha provided a reliability estimate of the tool, with evidence of high internal consistency (α = .92). The interrater reliability of the SITAT was also investigated. There was moderate absolute agreement across the 3 faculty raters using the 2-way mixed model design and “average” unit (kappa = 0.536, P = .000, 95% CI [0.34, 0.68]). The novel SITAT demonstrates internal consistency and interrater reliability when used for evaluation of individual performance during IPE simulation. The SITAT provides value in the education and evaluation of individual students engaged in IPE curriculum.
Becoming an Agile Change Conductor
(Frontiers, 2022) Mehta, Jade; Aalsma, Matthew C.; O'Brien, Andrew; Boyer, Tanna J.; Ahmed, Rami A.; Summanwar, Diana; Boustani, Malaz; Family Medicine, School of Medicine
Background: It takes decades and millions of dollars for a new scientific discovery to become part of clinical practice. In 2015, the Center for Health Innovation & Implementation Science (CHIIS) launched a Professional Certificate Program in Innovation and Implementation Sciences aimed at transforming healthcare professionals into Agile Change Conductors capable of designing, implementing, and diffusing evidence-based healthcare solutions. Method: In 2022, the authors surveyed alumni from the 2016–2021 cohorts of the Certificate Program as part of an educational quality improvement inquiry and to evaluate the effectiveness of the program. Results: Of the 60 alumni contacted, 52 completed the survey (87% response rate) with 60% of graduates being female while 30% were an under-represented minority. On a scale from 1 to 5, the graduates agreed that the certificate benefited their careers (4.308 with a standard deviation (SD) of 0.612); expanded their professional network (4.615, SD of 0.530); and had a large impact on the effectiveness of their leadership (4.288, SD of 0.667), their change management (4.365, SD of 0.742), and their communication (4.392, SD of 0.666). Graduates claimed to use Agile Processes (Innovation, Implementation, or Diffusion), storytelling, and nudging weekly. On a scale from 0 to 10 where 10 indicates reaching a mastery, the average score for different Agile competencies ranged from 5.37 (SD of 2.80) for drafting business proposals to 7.77 (SD of 1.96) for self-awareness. For the 2020 and 2021 cohorts with existing pre and post training competency data, 22 of the 26 competencies saw a statistically significant increase. Conclusion: The Graduate Certificate has been able to create a network of Agile Change Conductors competent to design, implement, and diffuse evidence-based care within the healthcare delivery system. Further improvements in building dissemination mastery and program expansion initiatives are advised.
A Blindfolded Pediatric Trauma Simulation and Its Effect on Communication and Crisis Resource Management Skills
(Cureus, 2021-11-11) Lopez de Alda, Juan X.; Patel, Nirali; McNinch, Neil; Ahmed, Rami A.; Emergency Medicine, School of Medicine
Background: Miscommunication is a common cause of medical errors and patient harm. Simulation is a good tool to improve communication skills, but there is little literature on advanced techniques to improve closed loop communication (CLC) in an effort to minimize medical errors. This study looks to evaluate whether blindfolding simulation participants is an effective tool in improving communication, and whether this advanced teaching technique is useful for critical pediatric scenarios. Methods: Participants included Emergency Medicine (EM) residents and Pediatric EM fellows with Advanced Trauma Life Support (ATLS) certification. Participants were randomized into groups and completed a pediatric trauma scenario. Recorded simulations were reviewed by three independent faculty for primary objective measures of total instances of communication and CLC utilization during critical actions in the simulation. The secondary objective was the perceived stress load by participants when utilizing this teaching methodology. Wilcoxon rank sum test (WRS), Fisher’s exact test (FET), and Cochran-Armitage test (CAT) were utilized for statistical analysis. Results: Statistically significant differences were noted in total communication between groups. Median and interquartile ranges (IQR) of total instances of communication were 17.0 (14.7-17.1) in non-blindfolded groups versus 21.0 (19.0-22.0) in blindfolded groups (p-value=0.002). Statistically significant increase in CLC was noted during the critical action of monitor placement in the blindfolded group (OR=13.7, 95% CI=1.4-133.8). No differences were noted in crisis resource management (CRM) scores. NASA Task Load Index (NASA-TLX) scores of both groups revealed similar stress levels. Statistical testing based upon the year of training was limited by small sample size and large number of categories. Conclusions: Blindfolded simulations increased total instances of communication overall and improved CLC in one critical action without increasing stress levels. The blindfolded trauma simulation exercise is an effective advanced technique to reinforce CLC utilization and communication skills.
Controversial COVID-19 Cures: Hydroxychloroquine and Oleander Pediatric Ingestion Simulation Cases
(Springer, 2022-06-21) Solano, Joshua J.; Mendelsohn, Rebecca A.; Ahmed, Rami A.; Shih, Richard D.; Clayton, Lisa M.; Alter, Scott M.; Hughes, Patrick G.; Emergency Medicine, School of Medicine
Introduction: The use of hydroxychloroquine has dramatically increased since being touted as a potential therapeutic in combating coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus. This newfound popularity increases the risk of accidental pediatric ingestion, whereby just one or two tablets causes morbidity and mortality from seizures, cardiac dysrhythmias, and cardiogenic shock. The unique management of hydroxychloroquine overdose makes it imperative for emergency medicine physicians to have familiarity with treating this condition. Similarly, during the COVID-19 pandemic, there have been publicized cases touting extracts of oleander as being a potential therapeutic against the illness. Since it is commonly available and potentially lethal ingestion with a possible antidote, we developed a simulation case based on the available literature. The two cases were combined to create a pediatric toxicology curriculum for emergency medicine residents and medical students. Both of these treatments were selected as simulation cases since they were being touted by prominent national figures as potential cures for COVID-19. Methods: Two series of simulation cases were conducted in a high-fidelity simulation lab with emergency medicine residents and medical students. The hydroxychloroquine simulation case involved the management of a four-year-old male who presented to the emergency department with nausea, vomiting, and tachycardia after ingesting hydroxychloroquine tablets. As the case unfolded, the child became increasingly unstable, eventually experiencing QT prolongation, torsades de pointes, and ventricular fibrillation arrest requiring appropriate resuscitation to achieve a return of spontaneous circulation. The oleander simulation case involved the management of a three-year-old male who presented to the emergency department with nausea, vomiting, and tachycardia after ingesting parts of an unknown plant. As that case progresses, the child becomes increasingly unstable, eventually experiencing atrial fibrillation, bradycardia, and degenerating into pulseless electrical activity and cardiac arrest requiring appropriate resuscitation to achieve the return of spontaneous circulation. Both series of simulation cases were modifiable based on trainee level and had the ability to include ancillary emergency department staff. Results: Each simulation case was performed six times at our simulation center, with a total of 22 learners for the hydroxychloroquine case, and 14 for the oleander case. Through pre- and post-simulation confidence assessments, learners demonstrated increases in knowledge of toxidromes, evaluating pediatric overdoses, treating cardiac dysrhythmias, performing pediatric advanced life support, and managing post-arrest care. Learners also demonstrated improvements in recognizing the unique treatment of hydroxychloroquine and oleander toxicity, the toxic dose of both substances in a child, and the most common electrolyte anomaly seen in each toxicity. Discussion: Simulation training enables learners to manage rare and complex disease processes. These cases were designed to educate trainees in recognizing and treating rare overdoses of emerging "therapeutics" that were touted early in the COVID-19 pandemic.
COVID-19 and Medical Education: A Four-Part Model to Assess Risks, Benefits, and Institutional Obligations During a Global Pandemic
(Elsevier, 2020-10-23) Barach, Paul; Ahmed, Rami A.; Nadel, Eric S.; Hafferty, Frederic; Philibert, Ingrid; Emergency Medicine, School of Medicine
The practice of medicine carries inherent risks, especially during outbreaks of highly contagious diseases like Ebola, H1N1, tuberculosis, and COVID-19. Exposure risks remain and extend to medical students and resident/fellows functioning in clinical settings and create ethical dilemmas around service vs. potential risks of illness. At the time of an unprecedented crisis in the US healthcare system, institutional leaders and medical educators are tasked with meeting patient care demands and ensuring the health and well-being of learners across the medical education continuum, while preventing stagnation in their education and promoting their professional growth. In this commentary, we offer a framework to guide medical schools and teaching hospitals leaders’ decisions around the deployment of these learners during the pandemic. To create the framework, we drew on information about minimizing the risks in inherently dangerous industries, practice during earlier outbreaks of dangerous infectious disease and guidance from ethics experts. We provide examples of how this risk framework can be applied to specific situations where medical students and residents/fellows function in a clinical context.
Creation and Implementation of a Large-Scale Geriatric Interprofessional Education Experience
(Hindawi, 2020-07-25) Mcquown, Colleen; Ahmed, Rami A.; Hughes, Patrick G.; Ortiz-Figueroa, Fabiana; Drost, Jennifer C.; Brown, Diane K.; Fosnight, Sue; Hazelett, Susan; Emergency Medicine, School of Medicine
The care of the older adult requires an interprofessional approach to solve complex medical and social problems, but this approach is difficult to teach in our educational silos. We developed an interprofessional educational session in response to national requests for innovative practice models that use collaborative interprofessional teams. We chose geriatric fall prevention as our area of focus as our development of the educational session coincided with the development of an interprofessional Fall Risk Reduction Clinic. Our aim of this study was to evaluate the number and type of students who attended a pilot and 10 subsequent educational sessions. We also documented the changes that occurred due to a Plan-Do-Study-Act (PDSA) rapid-cycle improvement model to modify our educational session. The educational session evolved into an online presession self-study didactic and in-person educational session with a poster/skill section, an interprofessional team simulation, and simulated patient experience. The simulated patient experience included an interprofessional fall evaluation, team meeting, and presentation to an expert panel. The pilot session had 83 students from the three sponsoring institutions (hospital system, university, and medical university). Students were from undergraduate nursing, nurse practitioner graduate program, pharmacy, medicine, social work, physical therapy, nutrition, and pastoral care. Since the pilot, 719 students have participated in various manifestations of the online didactic plus in-person training sessions. Ten separate educational sessions have been given at three different institutions. Survey data with demographic information were available on 524 participants. Students came from ten different schools and represented thirteen different health care disciplines. A large-scale interprofessional educational session is possible with rapid-cycle improvement, inclusion of educators from a variety of learning institutions, and flexibility with curriculum to accommodate learners in various stages of training.
Death notiﬁcation: a digital communication platform for simulated patient-based training with medical students
(BMJ Publishing Group, 2020-09-25) Hughes, Mary; Gerstner, Brett; Bona, Anna; Falvo, Lauren; Hobgood, Cherri; Ahmed, Rami A.; Emergency Medicine, School of Medicine
Medical simulation experiences, focused on enhancing essential communication skills, provide high value to trainees. These communication-based simulations often require little equipment and instead use trained faculty facilitators who can impart clinical significance and expertise to trainees. Teaching communication skills and techniques remotely is theoretically possible but has been largely unexplored in medical education.1 The COVID-19 pandemic and the subsequent restrictions imposed by shelter-in-place orders and social distancing created a need to expand traditional training methods and experiment with remote simulation training for communication skills. In this brief report, we explore the experience, outcomes and barriers to implementing a simulated communication skill curriculum focused on death notification to a cohort of remote medical students.

Browsing by Author "Ahmed, Rami A."

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