Dear Editor,Technology enhanced learning has made many advances in the field of medical education over the past twenty years.There has been the advent of e-learning,simulation,and multimedia resources to name but a fe...Dear Editor,Technology enhanced learning has made many advances in the field of medical education over the past twenty years.There has been the advent of e-learning,simulation,and multimedia resources to name but a few＂.Many of the advances made in technology enhanced learning,however,have followed traditional technologies in media and education.Thus,展开更多
Medical education is associated with significant costs[1].These costs have led to a growing interest in how to deliver high quality or high quantity education on a limited budget.This in turn has led to an interest in...Medical education is associated with significant costs[1].These costs have led to a growing interest in how to deliver high quality or high quantity education on a limited budget.This in turn has led to an interest in how best to measure quantity,quality and cost and how to track these variables over time.The ultimate aim of the interest in cost and value in medical education is to展开更多
BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and conclud...BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]<100 mmHg[1 mmHg=0.133 kPa]and administration of blood products)were eligible for inclusion.Death at hospital discharge was the primary outcome.RESULTS:During the study period,a total of 234 patients met the inclusion criteria.Among injured patients presenting with hemorrhagic shock,133(56.8%;95%confidence interval[CI]50.2%–63.3%)received TXA.Of patients that received TXA,a higher proportion of patients presented with shock index>1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.展开更多
Dear Editor： In the UK and in many other countries throughout the world, medical students are paying for their med- ical education~. They might be paying the entire fee or a sizable proportion of it - but many of the...Dear Editor： In the UK and in many other countries throughout the world, medical students are paying for their med- ical education~. They might be paying the entire fee or a sizable proportion of it - but many of them are increasingly making a contribution.展开更多
Dear Editor： Wang et al. should be congratulated for giving a comprehensive review of simulation training in healthcare[1]. Whilst all the points they make are cor- rect, they concentrate on the benefits of simulatio...Dear Editor： Wang et al. should be congratulated for giving a comprehensive review of simulation training in healthcare[1]. Whilst all the points they make are cor- rect, they concentrate on the benefits of simulation whilst largely ignoring the downsides of this new modality of medical education. The advantages of simulation by and large outweigh the disadvantages; however, the disadvantages are worth examining also -if only to get a balanced view. First of all, the authors ignore the costs of simula- tion. When the costs of hardware, software, facilities, faculty, and administrative and technology staff are all added UD, such costs will be substantial[2]展开更多
Simulation has made significant in-roads into the provision of medical education over the past twenty years. Simulation made its first impact in specialities such as emergency medicine and anaesthetics; however, it is...Simulation has made significant in-roads into the provision of medical education over the past twenty years. Simulation made its first impact in specialities such as emergency medicine and anaesthetics; however, it is now being used as an educational modality in a diverse range of specialities - from general practice to psychiatry. Perhaps the greatest pointer of the success of simulation is that it is now increasingly being seen as embedded in medical education and no longer something new and different. So now is probably an appropri- ate time to consider the future of simulation. Where will simulation go next？ It is likely that a number of different themes will emerge.展开更多
Medical education is an expensive activity.It is also a very long-term activity.Medical education interventions today will have impact up for 40 years into the future as today＇s medical students continue to practice ...Medical education is an expensive activity.It is also a very long-term activity.Medical education interventions today will have impact up for 40 years into the future as today＇s medical students continue to practice over a long career.The expense of medical education has led to a new interest in how to ensure maximum returns for educational investment.The new discipline of cost and value in medical education is clearly in its infancy with relatively few papers so far reporting rigorous results on the cost effectiveness or cost benefit or cost utility ratios of education interventions.展开更多
Dear Editor： Thirty-one countries in the world have no medi- cal schoolst[1]. This is an imperfect state of affairs. However it is one that is unlikely to last much longer as universities within these countries and ...Dear Editor： Thirty-one countries in the world have no medi- cal schoolst[1]. This is an imperfect state of affairs. However it is one that is unlikely to last much longer as universities within these countries and medical schools elsewhere move to close the gap.展开更多
Dear Editor： Medical education is associated with significant costs. Those who are responsible for the delivery of medical education must continually make deci- sions that have financial consequences. Sometimes deci...Dear Editor： Medical education is associated with significant costs. Those who are responsible for the delivery of medical education must continually make deci- sions that have financial consequences. Sometimes decisions are to invest in a new product or service, sometimes to disinvest. Sometimes decisions involve the educator realising that they should switch from one provider of medical education to another, or from one product to another. Consciously or unconsciously these decisions are inevitably made on value-educators want to maximise the outcomes from medical educa- tion or to minimise costs. But decisions to change inevitably involve cost in themselves-these are called switching costs （or sometimes switching barriers）.展开更多
Community based interventions increase knowledge scores and also have an impact of sexual behaviours with regard to HIV.However the problem remains as to how best to scale up these interventions and how best to overco...Community based interventions increase knowledge scores and also have an impact of sexual behaviours with regard to HIV.However the problem remains as to how best to scale up these interventions and how best to overcome real or perceived barriers to their uptake.Community based interventions have multiple components and some will be more difficult to widen out than others.Those that involve face to face or one to one sessions will be most expensive and so most difficult to scale up.If some interventions can be implemented by means of custom computerized risk reduction programmes,then roll out on a large scale should be less problematic.展开更多
文摘Dear Editor,Technology enhanced learning has made many advances in the field of medical education over the past twenty years.There has been the advent of e-learning,simulation,and multimedia resources to name but a few＂.Many of the advances made in technology enhanced learning,however,have followed traditional technologies in media and education.Thus,
文摘Medical education is associated with significant costs[1].These costs have led to a growing interest in how to deliver high quality or high quantity education on a limited budget.This in turn has led to an interest in how best to measure quantity,quality and cost and how to track these variables over time.The ultimate aim of the interest in cost and value in medical education is to
文摘BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]<100 mmHg[1 mmHg=0.133 kPa]and administration of blood products)were eligible for inclusion.Death at hospital discharge was the primary outcome.RESULTS:During the study period,a total of 234 patients met the inclusion criteria.Among injured patients presenting with hemorrhagic shock,133(56.8%;95%confidence interval[CI]50.2%–63.3%)received TXA.Of patients that received TXA,a higher proportion of patients presented with shock index>1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.
文摘Dear Editor： In the UK and in many other countries throughout the world, medical students are paying for their med- ical education~. They might be paying the entire fee or a sizable proportion of it - but many of them are increasingly making a contribution.
文摘Dear Editor： Wang et al. should be congratulated for giving a comprehensive review of simulation training in healthcare[1]. Whilst all the points they make are cor- rect, they concentrate on the benefits of simulation whilst largely ignoring the downsides of this new modality of medical education. The advantages of simulation by and large outweigh the disadvantages; however, the disadvantages are worth examining also -if only to get a balanced view. First of all, the authors ignore the costs of simula- tion. When the costs of hardware, software, facilities, faculty, and administrative and technology staff are all added UD, such costs will be substantial[2]
文摘Simulation has made significant in-roads into the provision of medical education over the past twenty years. Simulation made its first impact in specialities such as emergency medicine and anaesthetics; however, it is now being used as an educational modality in a diverse range of specialities - from general practice to psychiatry. Perhaps the greatest pointer of the success of simulation is that it is now increasingly being seen as embedded in medical education and no longer something new and different. So now is probably an appropri- ate time to consider the future of simulation. Where will simulation go next？ It is likely that a number of different themes will emerge.
文摘Medical education is an expensive activity.It is also a very long-term activity.Medical education interventions today will have impact up for 40 years into the future as today＇s medical students continue to practice over a long career.The expense of medical education has led to a new interest in how to ensure maximum returns for educational investment.The new discipline of cost and value in medical education is clearly in its infancy with relatively few papers so far reporting rigorous results on the cost effectiveness or cost benefit or cost utility ratios of education interventions.
文摘Dear Editor： Thirty-one countries in the world have no medi- cal schoolst[1]. This is an imperfect state of affairs. However it is one that is unlikely to last much longer as universities within these countries and medical schools elsewhere move to close the gap.
文摘Dear Editor： Medical education is associated with significant costs. Those who are responsible for the delivery of medical education must continually make deci- sions that have financial consequences. Sometimes decisions are to invest in a new product or service, sometimes to disinvest. Sometimes decisions involve the educator realising that they should switch from one provider of medical education to another, or from one product to another. Consciously or unconsciously these decisions are inevitably made on value-educators want to maximise the outcomes from medical educa- tion or to minimise costs. But decisions to change inevitably involve cost in themselves-these are called switching costs （or sometimes switching barriers）.
文摘Community based interventions increase knowledge scores and also have an impact of sexual behaviours with regard to HIV.However the problem remains as to how best to scale up these interventions and how best to overcome real or perceived barriers to their uptake.Community based interventions have multiple components and some will be more difficult to widen out than others.Those that involve face to face or one to one sessions will be most expensive and so most difficult to scale up.If some interventions can be implemented by means of custom computerized risk reduction programmes,then roll out on a large scale should be less problematic.
