Ramathibodi Medical Journal

Empowering Reflection and Reflective Writing in Medical Education

2024-06-26T09:17:31+07:00

Reflection and reflective writing serve as integral components in medical education. They enable students to delve deeper into their experiences, fostering a profound understanding of clinical scenarios and patient interactions, nurturing self-awareness, critical thinking, and empathy. The term “reflection” carries multiple interpretations, all encapsulating the concept of understanding oneself and the surrounding environment to inform future behavior. In the realm of medical education, both students and medical teachers encounter challenges in navigating reflective practices, necessitating guidance and support throughout the process. Effective reflection between students and medical teachers in clinical settings requires adept navigation through potential difficulties in open discussions and managing the emotional impact. To address these challenges, medical teachers must possess heightened self-awareness and adaptability to cater to the diverse needs of individual students. Various models have offered frameworks to organize the reflective process, categorizing them into ‘iterative’ and ‘vertical’ approaches. Successful application involves a selective combination of elements from different models to customize reflective practices. Comprehending reflection and reflective writing is paramount for medical teachers as it empowers them to mentor students effectively, nurturing a culture of reflective practitioners. This fosters continual learning, ethical practice, and professional development among future healthcare professionals.

The Effects of Changing Needles on Reducing Contamination of Postmortem Hemocultures

2024-06-26T09:17:20+07:00

Background: Sepsis is a common cause of death and can be diagnosed through postmortem hemoculture. However, this method carries the risk of contamination. Some experts have argued that using a new needle before inoculation can help reduce the contamination rates.

Objective: To evaluate the contamination rate from postmortem hemoculture in needle-changing and no-needle-changing groups.

Methods: The present study analyzed postmortem hemoculture results from autopsy cases at Ramathibodi Hospital. Forty deceased individuals who had died within 24 hours and were not suspected of having an infection were included in the study. The blood samples were divided into 2 groups: one in which the needle was changed before inoculation and the other in which it was not. Differences in hemoculture results between the 2 methods were examined.

Results: No statistically significant difference was detected in the positive culture rate between the needle-changing (57.5%) and non-needle-changing groups (57.5%) (P = 1.00). The Kappa coefficient was 0.795. Viridans group streptococci, Escherichia coli, Klebsiella pneumoniae complex, Enterobacter cloacae complex, and Acinetobacter baumannii complex were the most commonly cultured bacteria.

Conclusions: Changing the needles did not reduce the contamination rate from postmortem hemocultures. Microorganisms commonly found in postmortem hemocultures are oral, gastrointestinal, and hospital-associated microorganisms.

Efficacy of Reusable Rubber Moulage on Mannequin Versus Conventional Method for Burn Size Estimation

2024-06-26T09:17:35+07:00

Background: Burn size estimation is crucial to burn fluid resuscitation. Therefore, training and practice to improve the accuracy of burn size estimation is important. Using reusable rubber moulage (RRM), the newly developed equipment to cooperating with simulation might help improve the accuracy of burn size estimation compared to conventional picture illustration.

Objectives: To compare the accuracy of burn size estimation in simulation between picture illustration and RRM application, and to validate the face and content validity of RRM.

Methods: Medical students, ER residents, EP staff, and paramedics were recruited and randomized into 2 groups. Each group completed 2 different burn pattern stations consisting of one RRM-decorated mannequin station and one picture illustration station. The estimation of total body surface area (TBSA) percentage was statistically analyzed to determine the difference between the 2 methods. Face and content validation were analyzed by a Likert scale.

Results: A total of 70 participants were recruited. The means of total %TBSA of pattern 1 from RRM and picture illustration were 42.29% and 41.24% (P = .61), respectively. The means of pattern 2%TBSA estimation were 41.24% and 42.65% (P = .34), respectively. Participants rated RRM quality by Likert scale with means score more than 4 out of 5 in all questions. Written comments showed a preference toward RRM.

Conclusions: There were no significant %TBSA differences between RRM decorated mannequin and picture illustration in terms of %TBSA. However, participants were satisfied with RRM quality and preferred RRM decorated mannequin.

Exploring Journey, Experiences, and Expectation of Sleep Disorder Patient Before and After COVID-19 Pandemic in Sleep Disorder Center

2024-06-26T09:17:24+07:00

Background: The COVID-19 pandemic has globally affected society, health, and the economy, leading to changes in the delivery of patient services, particularly in sleep disorder centers.

Objectives: To explore the pathways, experiences, and expectations of patients who underwent sleep disorder evaluations before and after the COVID-19 outbreak.

Methods: A qualitative ethnographic study was conducted, employing in-depth interviews with 20 patients from the Department of Medicine who has previously undergone sleep studies at the sleep disorders center at least once, before March 20, 2020. These patients had a follow-up sleep study appointment for their second visit between March 1, 2022, and December 31, 2022. The data were analyzed using thematic analysis principles.

Results: The pathways of patients undergoing sleep disorder evaluations changed at certain service points after the COVID-19 outbreak. One significant change was the increased waiting time for evaluations (average of 9 months and 12 days) compared to the period before COVID-19 (average of 3 months and 27 days). Additionally, patient satisfaction increased significantly (85.22% compared to 78.17%) due to changes of services into touchless technology and the implementation of telemedicine. Five factors remain to develop for better patient experience: 1) procedures, documents, and appointment queues; 2) communication channels; 3) tools, equipment, and environment; 4) benefits and others, and 5) staff.

Conclusions: Based on the research findings, recommendations for improving crisis planning in sleep disorder centers include reducing waiting times, providing continuous staff training, and integrating technology.

The Work Life Balance and Performance Effectiveness of Orthopaedics Fellows and Residents in Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University

2024-06-26T09:17:28+07:00

Background: Fellows and residents in the Department of Orthopaedics have to work throughout the training program. The work life balance and work performance may affect work efficiency.

Objectives: To study and compare work life balance and work performance between fellows and residents in the Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University.

Methods: Data collection was using a 54-item that divided into 3 parts. Part 1 collected information about the respondents: gender, marital status, and income level. Part 2 assessed work life balance in 4 dimensions: work, social life, personal life, and economy. Part 3 examined the work performance in terms of efficiency and work behavior. Use analysis of variance to analyze the differences of work life balance between resident and fellow, determine the correlation between work life balance and characteristics of respondents, including the correlation between work life balance and work performance by multiple regression analysis.

Results: The respondents included 10 fellows and 36 residents. Among them, 39 (84.80%) were male, 36 (80.00%) were single, and 33 (71.80%) had an income between ฿20,001 to ฿30,000. Female had significantly higher work life balance in terms of work and economy compared to male. Fellows had significantly higher work life balance in terms of personal life compared to residents (32.80 and 38.60 points respectively, P = .03). Respondents with an income range of ฿30,001 to ฿40,000 had higher work life balance in terms of work and personal life compared to those in other income levels. Respondents who were married had higher work behavior performance compared to those who were single, and the work life balance inversely correlated with income levels.

Conclusions: The study findings can be used to analyze the causes and trends of work performance annually and provide guidance for developing training policies that promote a good work life balance, leading to the highest work performance.

Using Video Modeling in Enhance Social Skills to Children With Autism: A Literature Review

2024-06-26T09:17:38+07:00

The objective of this research paper is to explore the advantages, limitations, and empirical evidence for the effectiveness of video modeling as an instructional approach for children with autism. Video modeling, which falls under assistive technology in therapeutic intervention strategies, utilizes videos to exhibit desired behaviors and competencies. A total of 28 research articles, carefully selected from 3 reputable publication resources (APA PsycNet, Springer, and Eric), were analyzed through content analysis. These articles were published in online databases between 2000 and 2024. The following sections of the paper delve into the benefits of video modeling, including improved learning opportunities, increased engagement, and transferable skills. Furthermore, the paper presents empirical research findings that support the positive impact of video modeling on enhancing social skills in children with autism.