Design and Implementation of a Low-Cost Multimodal Procedure Cart for an Internal Medicine Ward
Bibliographic record
Abstract
INTRODUCTION: General internists perform a large number and variety of procedures in the ward and emergency department settings. Initiatives are needed to facilitate learning and increase efficiency of procedural skill acquisition by trainees. In this article, we describe our experience developing and implementing a low-cost multimodal procedure cart in an academic health sciences center. We also provide pilot data on perceived usefulness by trainees. METHODS: We performed a needs-assessment survey of residents, which indicated that the inconsistent location of materials and time needed to gather them were frustrating. Furthermore, residents reported that having easily accessible educational materials would improve their experience performing procedures. Based on this information, a portable cart was designed and implemented that had all materials required for common ward procedures, as well as multimodal educational materials, including evidence-based checklists, a hard-copy procedure manual, and a portable computer for viewing videos and logging procedures. The cart was equipped for the most commonly performed bedside procedures. After 2 months, we electronically surveyed residents on their experience with the intervention. Measures included self-reported frequency of use, satisfaction, perceived improvement in efficiency, and perceived improvement in patient safety. RESULTS: Residents perceived that the cart increased efficiency. The ready availability of educational materials was also noted as an advantage. Despite its perceived usefulness, trainees did not use the cart as frequently as anticipated. The cart continues to be in use > 1 year later, with modifications made based on feedback. CONCLUSIONS: In this article, we outline suggestions for successful implementation of a similar initiative based on our experience. We describe how a procedure cart can be inexpensively designed and instituted to facilitate more efficient performance of medical procedures and enhance education. Such an intervention may be beneficial in an academic as well as a community setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".