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To the point of the matter. Kobets AJ et al. An Intervention With Third-Year Medical Students to Encourage the Reporting and Management of Occupational Exposures. Academic Medicine 2012;87(9):1199-1203.

Reviewed by Lolita Alkureishi

What was the study question?
What impact did education regarding occupational exposures (such as needlestick injuries) and access to free post-exposure medication have on third-year medical student attitudes and reporting behaviors?

How was the study done?
Since 2001, Yale University in New Haven, Connecticut, all students meet with faculty in year one and year three to discuss occupational exposures. This comprehensive, supportive curriculum reviews the school policy that students are to leave the procedure and report the event, outlines how to access assistance and post-exposure prophylaxis, details the risks associated with exposures, and trains students how to assertively talk to residents and faculty about such events. As well, a laminated card is distributed to each student that contains this information as well as faculty phone numbers. Since 2011, a student with a serious exposure discusses his experience, available testing and counseling resources as part of the curriculum. Students were surveyed anonymously online in 2010 and 2011.

What were the results?
Students overall (96%) rated the educational intervention highly. Thirty-nine percent of the 2010 class and 35% of the 2011 class reported at least one exposure, several of whom reported multiple exposures. Most exposures occurred in the OR (77%). Twenty-four percent of exposures were do to another's actions. Fifty-nine percent knew what to do in the event of an exposure in 2010; 73% in 2011. Forty-three percent did not report their exposure, primarily because they believed it to be of low-risk. Other reasons cited for not reporting the exposure were feeling embarrassed or guilty for doing do and feeling discouraged by residents and attendings to report. The number of students that started post-exposure prophylaxis doubled from 2010 to 2011 from 12% to 24%.

What are the implications of these findings?
This curriculum was successful in supporting the students and increasing their safety.

Editor's note: Like the previous paper reviewed, this article reminds us that traditional educational initiatives (websites, teaching sessions, laminated cards, support people), while effective, only go so far. These authors, too, remain dedicated to the cause and are thinking creatively about how to address this problem in different ways. They propose a clever, original idea: that physicians identify a "universally accepted word that …could [be used] to indicate that sharps are close to others' hands in the operating room, in much the same way that golfers shout "fore" to warn of an incoming golf ball on the course" (SLB).

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