Diagnosing Death
No doubt many of you have heard the odd
'ghost story' involving nail scratch marks discovered on the inside lids of long occupied coffins. It seems when you are dead, you still may not have died yet? Now you can look to
BBC's Health reporter,
Anna-Marie Lever for incite into what may seem to those outside the medical profession or to even our novice medical students at UMHS, as probably the simplest diagnosis for a physician to make
~ diagnosing death. The article entitled
"How easy is it to diagnose death?" (BBC-Health column) questions that assumption.
The report cites various cases where patients were mistakenly declared dead or appear to have regained life, sometimes referred to as the
"Lazarus Syndrome". The question warrants further examination, especial by those students studying medical ethics this semester, as one quickly realizes the enormity of the medical, ethical and legal implications of a
misdiagnosis of death!
"Dr Daniel Sokol, a barrister and medical ethicist at Imperial College London, said: "The implications of confirming a person dead are enormous, and hence doctors have an ethical obligation to ensure that they 'diagnose' death with due care and skill."
Note the
Uniform Determination of Death Act (UDDA) provides this definition:
§ 1. [Determination of Death]. An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
Read the full article posted this morning (October 17, 2012) online at BBC News - Health. Labels: determining death, diagnosing death, diagnostic skills, ethics, medical diagnosis, medical ethics, medical student competencies, physical assessment, UMHS-SK courses
Facing the Challenge of Teaching Evidence-Based Medicine to Medical Students
I would encourage you all to read this article!
George P., Reis S., Nothnagle M., (2012). Using a Learning Coach to Teach Residents Evidence-based Medicine.
Family Medicine, 44(5), 351-355. http://www.stfm.org/fmhub/fm2012/May/Paul351.pdf
This study demonstrates how important the acquisition of
‘information mastery skills’ are to physician success in practicing evidence-based medicine! It shows what one university medical school did to try to improve these skills in their students, targeting their second year family medicine residents. [Alpert Medical School, Brown University, Family Medicine Residency Program and the Department of Family Medicine, Memorial Hospital of Rhode Island]
The article quotes the current ACGME accreditation competency:
“The ACGME requires that residents demonstrate competency in information mastery or the ability to 'locate, appraise, and assimilate evidence from scientific studies'.“
Reiterated in the
ACGMEs Next Accreditation System (NAS) ‘General Milestones’
*:
(adopting July 2013)
Level 2: (residents) “Formulates a searchable question from a clinical question (e.g., using PICO format).”
Level 3: (residents) “Applies a set of critical appraisal criteria to different types of research, including synopses of original research findings, systemic reviews and meta-analyses, and clinical-practice guidelines.” “Critically evaluates information from others.”
Level 4: (graduating resident) “Demonstrates a clinical practice that incorporates principles and basic practices of evidence-based practice and information mastery.”
Overall, I agree with the approaches taken by the developers of the course, the
one-on-one coaching model coupled with being a
structured component of the curriculum, and would encourage the adoption of a similar type of program at UMHS. Post intervention assessment of the resident’s EBM knowledge showed a notable increase of
31.8% , along with improved attitudes toward EBM and its increased use in the clinical setting. However there is still room for improvement as the average score on the posttest was still only 58%!
A few areas I suggest warrant further consideration or emphasis when undertaking such a program :
- stressing the quality and value of subscription clinical point-of-care databases, full-text journal databases, and other library resources.
- the integral involvement of the medical librarians in the program (course development, delivery, and evaluation).
- incorporating the ‘6S’ model ** for accessing pre-appraised evidence and providing directional steps to the search process.
- augmenting the course with training in current methods for staying up-to-date while navigating the flood of medical information, such as RSS alerting.
- recognizing that information resources are dynamic and will continue to challenge the information searcher’s flexibility and adaptability. Thus, it is important that the program emphasize teaching the concepts of information searching rather than focusing on the idiosyncrasies of any individual resource, or promoting dependency on any one database.
- working toward seamless integration of relevant evidence-based clinical information into the individual patient’s electronic medical record (a CDSS or Computerized Decision Support System).
Evidence-based practice isn’t just about finding
an answer to your clinical question, it is finding the
current best answer based on the peer-reviewed medical evidence, for the care of your particular patient.
I invite your comments ….
Ann Celestine,
Library Director
http://lib.umhs-sk.net/
*Nasca, T. J., Brigham, T., Philibert, I., & Flynn, T. C. (2012).
The Next GME Accreditation System — Rationale and Benefits. New England Journal Of Medicine, 366(11), 1051-1056. doi:10.1056/NEJMsr1200117.
**DiCenso, A., Bayley, L., & Haynes, R. (2009).
Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12(4), 99-101. doi:10.1136/ebn.12.4.99-b
Labels: evidence-based medicine, evidence-based practice, information literacy, medical education, medical information search, medical student competencies, medical students
