Lessons learned from thesis

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Lessons learned from thesis

February 13th, By: Chan, can you take a look at this ECG for Bed 8? As an academic emergency physician EPI might see two dozen patients or more in a single 8-hour shift—and that is on a slower day!

In my province of Ontario, our emergency care systems are constantly under pressure. As a result, the emergency department ED is now well-known as a busy, chaotic environment, but is, by and large, the main portal for patients to enter into modern acute care hospitals.

EDs are rife with complex and increasingly sick patients, and the modern EP is tasked with organizing care for many patients simultaneously.

The skill of managing the multiplicity of patients in a single ED, however, was a bit of a mystery to me. To be honest, I still recall one day in my final year of residency training when I looked at the ED tracker board and was struck by the realization that I knew all the details and plans for all 16 patients listed.

As medical students, we are taught the traditional case analytic method. This method served me very well in my first clerkship rotation internal medicine and continued to serve me well throughout my medical school training when I only had to manage one patient at a time.

Then as a junior resident, I generally had to actively manage a small portfolio of 2—3 patients that I got to know really well. That process was hard: Fascinated by my own educational experience, I decided to spend some time exploring the phenomenon of multi-patient environments for my thesis.

We found that in busy environments, attendings tended to focus on macro-level issues around patient flow and ensuring the system was working well, while residents focused on the complexities of individual cases.

Attendings also felt it was essential that junior residents demonstrate their ability to take care of smaller groups of patients well before they could effectively learn to coordinate care for many more patients simultaneously. In our next paper, recently published in Academic Medicinewe explored the actual thinking processes of attending physicians and residents as they talked their way through setting priorities in a multi-patient environment.

We discovered that the clinicians even the most junior ones read the triage notes and partial charts that were available to them to generate functional patient stories. These stories allowed them to organize and parse the information about each of the patients, and consequently allowed them to compare relative priorities and begin setting a list.

Putting both of our papers in context, the intuitive emphasis that attendings put on understanding each patient case well makes sense.

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In contrast with chess, which has a finite number of pieces and moves, sick patients are always subtly different, and as such, it may take much more exposure to become aware of the more subtle differences between cases. However, learning to anticipate how a high-risk chest pain patient might differ from a low-risk chest pain patient or from a patient with abdominal pain would be critically important for junior trainees to master before they proceed on to managing multiple patients.

When managing multiplicity, however, it is important to know that this chunking phenomenon occurs as a necessary and adaptive step within multi-patient environments. To handle multiple patients, clinicians must chunk data to form new bundles of more easily memorizable information.

This process, while necessary and adaptive for these complex environments may explain how or why certain types of cognitive errors may occur in busier situations.

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And yet, to date, studies of diagnostic error and clinical decision-making have mostly focused on environments where clinicians are faced with single patients. We hope our work might help to provide more conceptual grounding for those interested in combatting diagnostic error and improving clinical decision-making.

Lessons learned from thesis

University of Illinois at Chicago; Accessed February 8, On the basis of some key learned lessons on the nature of innovation and technological change, we assess four theses about TRIPS and its impact on the global generation and distribution of knowledge.

Finally, the policy implications concerning international organisations and technological transfer are . AD-A CONSTRUCTABILITY IMPROVEMENT: MAKING EFFECTIVE USE OF CONSTRUCTION LESSONS LEARNED by Robert Henry Morro O TI DT AN24 Z, ZGE?

Thesis submitted to the Faculty of the Graduate School.

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Late in Florida International University’s Digital Collections Librarian, Rebecca Bakker, began a lofty and ambitious project: seeking permissions from over 4, alumni to post their theses and dissertations to FIU Digital Commons.

The repository now includes about 80% of the works she has investigated. Much of the project was . Lessons that can be learned from his life and leadership are also identified, including the extent to which his life and messages learned reinforce or contradict the leadership concepts.

According to Bennis and Thomas (), a crucible of leadership is a trial that brought upon deep reflection that forced one to examine their values and are.

boston university school of medicine thesis lessons to be learned from three mass casualty events - boston marathon bombing, aurora movie theatre. Lessons Learned from the Bosnian Conflict Ahmed Saeed A thesis submitted to the Graduate Faculty of JAMES MADISON UNIVERSITY In Partial Fulfillment of the Requirements.

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