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TUNNEL VISION: HOW GOOD ARE FINAL YEAR MEDICAL STUDENTS IN IDENTIFYING DIFFERENTIAL DIAGNOSIS ON A BUSY WARD ROUND: A SIMULATED WARD ROUND AT THE UNIVERSITY OF EDINBURGH
  1. Karima Medjoub
  1. NHS Plastic Surgery Registrar, Fellow in Clinical Simulation, UK

Abstract

Background Aggressive patients can be either distracting to the participants, and often their behaviour can be attributed to personality traits. However, it is common knowledge amongst medical healthcare professionals that it is potentially a symptom of an organic cause. Therefore, in a complex and stressful environment, such as a ward round, how likely is a medical student to identify the potential of a serious illness in an aggressive patient?

Methodology We ran a simulated ward round at the university of Edinburgh involving final year medical students (n=290). We used five patient scenarios with numerous distractors such as phone calls, being asked to perform other tasks, and requesting investigations, as well as being a part of the ward round. Two of the scenarios used were around one patient with acute pancreatitis and another with sepsis and airway compromise. Both these simulated patients were instructed to be aggressive. We measured the time between the patient expressing symptoms to the time of considering a possible cause of the patient's symptoms, and also the number of prompts from faculty and the patients required to do so.

Results There were a significant number of missed sessions where the diagnosis was missed die to distractions. The required number of prompts was higher in patients and nurse than those of consultants, reflecting the effect of hierarchy. During the debrief, the importance of understanding and acquisition of non-technical skills are an important factor is diluting distractors and avoid potentially disastrous outcomes were discussed. Work around the subject should be continued in the future as part of the undergraduate curriculum.

Conclusions Distractors on a busy ward round are to be taken seriously by medical staff. It is crucial to stop, delay or manage the distractors as appropriately to avoid serious mistakes.

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