Recent uciem_westjem items

Association of Social Needs and Housing Status Among Urban Emergency Department Patients

Fri, 28 Oct 2022 00:00:00 +0000

Introduction: People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness.

Methods: We surveyed patients in an urban, safety-net ED from June–August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability.

Results: Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29-57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness...

Gender Evaluation and Numeric Distribution in Emergency Medicine Residencies (GENDER): A Retrospective Analysis of Gender Ratios Among Residents and Residency Directors from 2014-2017

Mon, 24 Oct 2022 00:00:00 +0000

Introduction: While females make up more than half of medical school matriculants, they only comprise about one third of emergency medicine (EM) residents. We examined EM residency cohorts with entering years of 2014–2017 to estimate the ratio of males to females among residents and program leadership to determine what correlation existed, if any, between program leadership and residency gender distributions.

Methods: We identified 171 accredited EM residency programs in the United States with resident cohorts entering between 2014-2017 with publicly available data that were included in the study. The number of male and female residents and program directors were counted. We then confirmed the counts by contacting the programs directly to confirm accuracy of the data collected from program websites.

Results: Within the included...

Moving Beyond the Binary: How Language and Common Research Practices Can Make Emergency Medicine Less Welcoming for Some Learners and Physicians

Mon, 24 Oct 2022 00:00:00 +0000
Moving Beyond the Binary: How Language and Common Research Practices Can Make Emergency Medicine Less Welcoming for Some Learners and Physicians

Racial Disparities in Opioid Analgesia Administration Among Adult Emergency Department Patients with Abdominal Pain

Mon, 24 Oct 2022 00:00:00 +0000

Introduction: Racial disparities in pain management have been reported among emergency department (ED) patients. In this study we evaluated the association between patients’ self-identified race/ethnicity and the administration of opioid analgesia among ED patients with abdominal pain, the most common chief complaint for ED presentations in the United States.
Methods: This was a retrospective cohort study of adult (age ≥18 years) patients who presented to the ED of a single center with abdominal pain from January 1, 2019–December 31, 2020. We collected demographic and clinical information, including patients’ race and ethnicity, from the electronic health record. The primary outcome was the ED administration of any opioid analgesic (binary). Secondary outcomes included the administration of non-opioid analgesia (binary) and administration of any analgesia (binary). We used logistic regression models to estimate...

Management and Outcome of COVID-19 Positive and Negative Patients in French Emergency Departments During the First COVID-19 Outbreak: A Prospective Controlled Cohort Study

Mon, 24 Oct 2022 00:00:00 +0000

Introduction: Few studies have investigated the management of COVID-19 cases from the operational perspective of the emergency department (ED), We sought to compare the management and outcome of COVID-19 positive and negative patients who presented to French EDs.
Methods: We conducted a prospective, multicenter, observational study in four EDs. Included in the study were adult patients (≥18 years) between March 6–May 10, 2020, were hospitalized, and whose presenting symptoms were evocative of COVID-19. We compared the clinical features, management, and prognosis of patients according to their confirmed COVID-19 status.
Results: Of the 2,686 patients included in this study, 760 (28.3%) were COVID-19 positive. Among them, 364 (48.0%) had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese,...

Are Oblique Views Necessary? A Review of the Clinical Value of Oblique Knee Radiographs in the Acute Setting

Mon, 24 Oct 2022 00:00:00 +0000

Introduction: The purpose of this study was to assess the added clinical value of oblique knee radiographs four-view (4V) compared to orthogonal anteroposterior (AP) and lateral radiographs in a two-view (2V) series.
Methods: We obtained 200 adult, 4V knee radiographs in 200 patients in the ED and randomly divided them into two groups with 100 series in each group. Ten reviewers — three musculoskeletal radiologists and seven orthopedic surgeons — performed radiograph analyses. These reviewers were randomly divided evenly into group one and group two. Reviewers were blinded to patient data and first reviewed 2V radiographs (AP/lateral) only, and then reviewed 4V radiographs, including AP/lateral, and two additional oblique views for the same patients at least four weeks later. Acute pathology identification and the need for further imaging was assessed for all reviewers, and clinical decision-making (operative...

Trends of Regional Anesthesia Studies in Emergency Medicine: An Observational Study of Published Articles

Mon, 24 Oct 2022 00:00:00 +0000

Introduction: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research.
Methods: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends....

Opioid Analgesic Use After an Acute Pain Visit: Evidence from a Urolithiasis Patient Cohort

Sun, 23 Oct 2022 00:00:00 +0000

Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge.
Results: Among 892 adult ED patients with urolithiasis, 79%...

Post-abortion Complications: A Narrative Review for Emergency Clinicians

Sun, 23 Oct 2022 00:00:00 +0000

An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than...

Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department

Sun, 23 Oct 2022 00:00:00 +0000

Introduction: Frostbite leads to progressive ischemia eventually causing tissue necrosis if not quickly reversed. Patients with frostbite tend to present to the emergency department (ED) for assessment and treatment. Acute management includes rewarming, pain management, and (when indicated) thrombolytic therapy. Thrombolytic therapy in severe frostbite injury may decrease rates of amputation and improve patient outcomes. Fluorescence microangiography (FMA) has been used to distinguish between perfused and non-perfused tissue. The purpose of this study was to evaluate the potential role of FMA in the acute care of patients with frostbite, specifically its role as a tool to identify perfusion deficit following severe frostbite injury, and to explore its role in time to tissue plasminogen activator (tPA).
Methods: This retrospective analysis included all patients from December 2020–March 2021 who received FMA in a single ED as part of their...

Accuracy of Point-of-care Ultrasound in Diagnosing Acute Appendicitis During Pregnancy

Sun, 23 Oct 2022 00:00:00 +0000

Introduction: Acute appendicitis is the most common non-obstetrical surgical emergency in pregnancy. Ultrasound is the imaging tool of choice, but its use is complicated due to anatomical changes during pregnancy and depends on the clinician’s expertise. In this study, our aim was to investigate the diagnostic accuracy of point-of-care ultrasound (POCUS) in suspected appendicitis in pregnant women.
Methods: We conducted a retrospective analysis of all pregnant women undergoing POCUS for suspected appendicitis between June 2010–June 2020 in a tertiary emergency department. The primary outcome was to establish sensitivity, specificity, and likelihood ratios of POCUS in diagnosing acute appendicitis, overall and for each trimester. We used histology of the appendix as the reference standard in case of surgery. If appendectomy was not performed, the clinical course until childbirth was used to rule out appendicitis. If the patients underwent...

COP27 Climate Change Conference: urgent action needed for Africa and the world

Sat, 22 Oct 2022 00:00:00 +0000

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change

2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs

Thu, 20 Oct 2022 00:00:00 +0000

Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting.
Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health.
Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating...

High-Risk Return Visits to United States Emergency Departments, 2010–2018

Tue, 18 Oct 2022 00:00:00 +0000

Objectives: Although factors related to a return visit to the emergency department (ED) have been reported, only few studies have examined “high-risk” ED revisits with serious adverse outcomes. This study aimed to describe the incidence and trend of high-risk ED revisits in United States EDs and to investigate factors associated with these revisits.
Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010–2018. Adult ED revisits within 72 hours of a previous discharge were identified using a mark on the Patient Record Form. High-risk revisits were defined as revisits with serious adverse outcomes, including intensive care unit admissions, emergency surgery, cardiac catheterization, or cardiopulmonary resuscitation (CPR) during the return visit. Analyses used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design.
Results:...

Compassion Fatigue: A Quantitative Analysis of the Effects on Ancillary and Clinical Staff in an Adult Emergency Department

Tue, 18 Oct 2022 00:00:00 +0000

ABSTRACT
Introduction: Emergency department (ED) staff are at a high risk for compassion fatigue (CF) due to a work environment that combines high patient acuity, violence, and other workplace stressors. This multi-faceted syndrome has wide-ranging impacts which, if left untreated, can lead to adverse mental health conditions including depression, anxiety, and substance use disorders. However, the majority of studies examining CF look solely at clinicians; as a result, there is no information on the impact of CF across other roles that are involved in supporting patient care. We conducted this study to establish the prevalence of CF across both clinical and non-clinical roles in the adult ED setting.
Methods: For this single institution cross-sectional study, all full- and part-time ED staff members who worked at least 50% of their shifts in the ED or within the adult trauma service...

Reducing Covid-19 Health Inequities Through Identification of Health-Related Social Needs and Clinical Deterioration in Patients Discharged from the Emergency Department

Tue, 18 Oct 2022 00:00:00 +0000

Introduction
The decision to discharge a patient from the hospital with confirmed or suspected COVID-19 is fraught with challenges. Patients who are discharged home must be both medically stable and able to safely isolate to prevent disease spread. Socioeconomically disadvantaged patient populations in particular may lack resources to safely quarantine and are at high risk for COVID-19 morbidity.
Methods
We developed a telehealth follow-up program for emergency department (ED) patients who received testing for COVID-19 from April 24 to June 29, 2020 and were discharged home. Patients who were discharged with a pending COVID-19 test received follow up calls on Days 1, 4 and 8. The objective of our program was to screen and provide referrals for health-related social needs (HRSNs); conduct clinical screening for worsening symptoms; and deliver risk-reduction strategies for vulnerable individuals. Retrospective chart...

The Effect of COVID-19 on United States Pediatric Emergency Departments and its Impact on Trainees

Tue, 18 Oct 2022 00:00:00 +0000

Introduction
The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PEDs) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models.
Methods
We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based REDCap questionnaire. The survey was sent via 3 national pediatric emergency medicine distribution lists, with several follow-up reminders.
Results
There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for early pandemic (March-July 2020), and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased > 32% for each studied...

Effects of Emergency Transfer Coordination Center on Length of Stay of critical patients in the Emergency department

Tue, 18 Oct 2022 00:00:00 +0000

Introduction
Critically ill patients are frequently transferred from other hospitals to the Emergency department (ED) of tertiary hospitals. Due to the unforeseen transfer, the ED length of stay (LOS) of the patient is likely to be prolonged along with other adverse effects. The present study aimed to confirm whether the establishment of an organized unit called the Emergency Transfer Coordination Center (ETCC) to systematically coordinate emergency transfers is effective in reducing the ED LOS of transferred critically ill patients.
Methods
The present study is a retrospective observational study focusing on patients who were transferred from other hospitals and admitted to the intensive care unit (ICU) of the ED in a tertiary hospital located in northwestern Seoul, the capital city of South Korea from January 2019 to December 2020. The exposure variable of the study was ETCC approval before transfer and ED LOS was...

The Emergency Medicine Education & Research by Global Experts (EMERGE) Network: Challenges and Lessons Learned

Tue, 18 Oct 2022 00:00:00 +0000

Introduction: The Emergency Medicine Education and Research by Global Experts (EMERGE) network was formed to generate and translate evidence to improve global emergency care. We share the challenges faced and lessons learned in establishing a global research network.

Methods: We describe the challenges encountered when EMERGE proposed the development of a global Emergency Department (ED) visit registry. The proposed registry was to be a 6-month, retrospective, deidentified, parsimonious dataset of routinely collected variables, such as patient demographics, diagnosis, and disposition.

Results: Obtaining reliable, accurate, and pertinent data from participating EDs is challenging in a global context. Barriers experienced ranged from variable data taxonomies, need for language translation, varying processes for data cleaning and transfer of deidentified data, navigating numerous data protection regulations and substantial variation in each...

WestJEM Full-Text Issue

Tue, 20 Sep 2022 00:00:00 +0000
WestJEM Full-Text Issue

MEMC Abstracts Special Issue

Mon, 19 Sep 2022 00:00:00 +0000
23.5.1

Slack Intern Curriculum Supports Intern Preparedness and Bridges Curriculum Gaps due to COVID-19

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: Assess the effectiveness of social media implementation of an Accreditation Council for Graduate Medical Education (ACGME) milestone-based curriculum during the spring 2020 U.S. COVID-19 surge. The hypothesis is that pre-interns will report improvements in PP regarding multiple ACGME milestone topics.
Background: Transitioning to residency involves translation of academic knowledge into clinical acumen, and is complicated by variable medical school experiences. The COVID-19 pandemic presented a new challenge by displacing students from clinical rotations. Virtual educational modalities such as the Slack Intern Curriculum (SIC) have increased newly-matched “pre-intern” perceived preparedness (PP) for residency in prior years, but the SIC had never been implemented or evaluated in a pandemic with disrupted medical education.
Methods: The SIC was constructed using topics from 8 ACGME milestones in emergency medicine (EM), incorporated into 8 clinical scenarios....

Impact of a Best Practice Alert on the Implementation of Expedited Partner Therapy

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The objective of this study was to determine if an ED-based electronic health record (EHR) Best Practice Alert (BPA) increased the ordering of expedited partner therapy (EPT) for sexually transmitted infections (STI) in adult patients.
Background: US EDs have reported increases in STI visits and positivity rates, mirroring record level increases in STI incidence in the general population. EPT is an evidence-based practice recommended by public health experts for treating sexual partners of STI patients. EDs typically evaluate patients for STIs without their sexual partner present, thereby providing opportunities for EPT. However, EPT is infrequently used in US EDs.
Methods: This pilot study was part of a quality improvement initiative conducted between August and October 2021 in an academic tertiary care ED located in the Midwest. An EPT BPA was randomly displayed in the EHR to clinicians when they empirically treated adult ED patients for STIs with...

Cluster analysis of regional use patterns among critically ill emergency patients in Korea

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The aim of this study was to analyze the inflow and outflow of critically ill emergency patients in Korea using National Emergency Department Information System (NEDIS) data for the last five years (2014-2018).
Background: In Korea, an imbalance across regions in emergency medical services has been creating a continuous barrier to ensuring access to such services for all residents. Korea’s medical delivery system is not efficiently linked and a concentration of patients and medical resources in certain areas has continued due to the inefficiency of the competition between medical institutions from primary private clinics and tertiary hospitals.
Methods: Using the relevance index (RI) and the commitment index (CI) for analysis, the optimal number of clusters was determined and K-means cluster analysis was performed using the determined number of clusters in the cities, counties, and districts across the country. We classified regional types and expressed...

Utilization and Cost Savings of an Emergency Department Acetaminophen Route Pathway

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: To evaluate the cost savings of an acetaminophen route pathway in patients presenting to the emergency department.
Background: The use of intravenous acetaminophen (IVA) has been increasing since it was approved by the Food and Drug Administration in 2010. However, the cost of IVA is orders of magnitude more than the oral version with significant cost variation based on hospital formulary. Despite the cost difference, multiple studies have shown that the IV version is not more effective than enteral forms. By implementing an Acetaminophen Route Pathway (ARP), we hypothesize a reduction in unnecessary use of IVA and significant cost savings.
Methods: A prospective, before-after controlled study was conducted. ED ARP was designed by expert/consensus opinion and rolled out with a discussion at faculty and resident staff meetings followed by reminder emails. The electronic medical record logged every instance of IVA administration 12 months before and after...

Characterization of Oxycodone Misuse using National Survey Data.

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The objective of the study is to characterize the risk markers of oxycodone misuse using the nationally representative National Survey of Drug Use and Health (NSDUH) data.
Background: Drug overdoses continues to be a public health crisis with 70,630 fatalities in 2019. Approximately two-thirds of these deaths (66%) involved a prescription or illicit opioid. Synthetic opioids accounted for 72.9% of opioid-involved overdose deaths in 2019.
Methods: The 2019 NSDUH public use cross-sectional data were analyzed. The respondents were classified into two groups, past year oxycodone misusers and non-misusers, based on the screening questions assessing past year misuse of oxycodone products. The prevalence of selected demographic, clinical factors and substance use and abuse, including prescription medications, was assessed descriptively for the two population groups using cross tabulated frequencies and chi-square tests. Logistic regression models using a backward...

Proportion of Emergency Department Visits for Alcohol Abuse Increased After the Arrival of COVID-19

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19.
Background: In March of 2020, COVID-19 arrived in the New York Metropolitan area. Total ED visits decreased markedly, likely because of fear of exposure to the virus as well as social isolation mandates. Concerns have been raised regarding the possible adverse effects that COVID-19 may have on increased abuse of alcohol. COVID-19 triggered bouts of anxiety, isolation from peers, and increased family tensions because of job disruptions and quarantining within families. A CDC study showed that despite decreased total ED visits, compared to 2019, the proportion of ED mental health related visits in 2020 increased. The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19.
Methods: Design: Retrospective cohort. Setting:...

Effect of the COVID-19 Pandemic on ED Adult Psychiatric Visits

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: Our goal was to determine whether the proportion of ED visits for specific psychiatric conditions, namely anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, changed after the arrival of COVID-19.
Background: In March 2020, the COVID-19 pandemic reached the New York tri-state area, which, at the time, was one of the regions in the United States (US) that the virus most severely affected. ED visits dramatically declined, likely due to social isolation mandates and fear of exposure to the virus. Quarantining at home, fear of becoming sick, and job disruptions caused the level of stress in the population to increase. In a previous US study, the proportion of ED visits for some psychiatric conditions increased.
Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban and urban areas. Total annual ED...

Incorporating a Resident-Driven Mentorship Program into Emergency Medicine Clerkship Rotations

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: We launched an EM resident-driven mentorship program to help medical students excel in their clerkships, develop relationships, and navigate residency applications. We hypothesize that students will rate the mentoring positively and will report that it improved their performance.
Background: Mentorship is important for professional growth and success in medicine. There are few formal mentorship programs for medical students on audition rotations.
Methods: Students were assigned a self-selected EM resident mentor for their four-week clerkship at a single institution. Allopathic and osteopathic students were matched with residents from MD or DO schools, respectively. Mentors were instructed to review: patient presentations, differential diagnoses, clinical decision-making tools, rotation advice, and the application and match process. Mentors were instructed to meet with their mentees and to check-in weekly. Following the rotation, students were sent an...

Effectiveness of face mask mandates in 4 suburban US communities during the SARS-CoV2 Omicron surge

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: To evaluate the effectiveness of face mask mandates in four suburban communities in the metropolitan Boston area during the SARS-CoV2 Omicron surge.
Background: Face mask mandates have been implemented by local, state and national governments to limit the transmission of illness during the SARS-CoV2 pandemic.
Methods: A retrospective review of state reported, PCR positive cases of SARS-CoV2 and vaccination rates in four communities during the Omicron surge from 01/11/21-01/31/22. Data was analyzed using descriptive statistics.
Results: Two communities had a face mask mandate in place for all indoor public spaces throughout the study period, and two communities did not. Brookline (population 59,180, fully vaccinated rate per capita 62%) and Newton (population 88,593, vaccination rate 87%) implemented face mask mandates prior to the surge on 08/27/21 and 09/02/21, respectively, that remained in place through 02/18/22. Needham (population 31,248,...

Variation in Trauma Team Response Fees in United States Trauma Centers

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: Investigate the variation of the trauma team response fee (TTRF) among all levels of Trauma Centers (TC) Level I-IV, in different geographic regions in the U.S. (Midwest, West, South, Northeast U.S.).
Background: Investigate Hospital Medical Directors (HMD) and Trauma Medical Directors (TMD) knowledge of TTRF dollar amount in their institution.
Methods:Setting 525 American College of Surgeons verified trauma centers (TC) in the U.S. Level I-IV TCs.TC’s in the continental U.S including Alaska and Hawaii.Data Collection Cross-sectional convenience sample. Online survey development cloud-based software, Survey Monkey.Responses from October 8, 2019 through March 11, 2020.
Results: True costs of TTRF’s in the U.S remains elusive due to inadequate data. TTRF’s were higher in level II TC’s in the West compared to Level I’s. No statistically significant difference in TTRF’s despite geographical and cost of living differences. 41.3% of HMD are aware...

Metal Detectors Improve Patients’ Sense of Safety in the Emergency Department

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: We aimed to assess the impact of metal detectors on patients’ feelings of safety in the ED.
Background: National guidelines recommend hospitals attempt to prevent weapons from entering EDs. Metal detectors have been shown to reduce the number of weapons coming into EDs. However, there are concerns that they are unwelcoming to patients and might discourage them from seeking care. Less than one third of hospitals in the United States utilize metal detectors. The most recent ED based studies of patients’ attitudes towards metal detectors were over 25 years ago, and patients’ perceptions of safety likely have evolved during this time.
Methods: We surveyed a convenience sample of patients and their companions >18 years of age, who had undergone metal detection at the entrance of our suburban, academic ED from 2019-2021. Using tailored design, we developed survey questions with a consensus panel of physicians, nurses, and patients. We pilot tested the survey...

Analysis of Time-to-Disposition Intervals During Early and Late Parts of a Shift

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: To assess whether time-to-disposition is significantly different when a patient is seen by a provider during the early half or late half of a shift.
Background: Time-to-disposition is an important metric for emergency department throughput. We hypothesized that providers view the shift end as a key timepoint and attempt to leave as few dispositions as possible to the oncoming team, thereby making quicker decisions later in the shift. This study evaluates disposition distribution relative to when patients are assigned a provider during the course of a shift.
Methods: 50,802 cases were analyzed over the one-year study interval. 31,869 patients were seen in the early half of a shift (hours 1-4) and 18,933 were seen in the later half (hours 5+). We ran a linear mixed model that adjusted for age, gender, emergency severity index score, time of day, weekend arrivals, quarter of arrival and shift type.
Results: Median time-to-disposition for the early...

Utilization of Telehealth Solutions for Patients with Opioid Use Disorder Using Buprenorphine: A Scoping Review

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: A scoping review was conducted to examine the breadth of evidence related to telehealth innovations being utilized in the treatment of Opioid Use Disorder (OUD) with buprenorphine and its effect on patient outcomes and healthcare delivery.
Background: With the opioid epidemic worsening from year to year, there is a critical need to connect with this growing population and get them access to life-saving interventions. Buprenorphine is shown to be associated with lower overdose rates and a decrease in opioid-related acute care, but has historically been underutilized in treatment for OUD. Previous studies have determined that geographical barriers and lack of access to DEA-waivered providers are common obstacles towards starting MAT. Telehealth presents itself as a solution to this discrepancy and is becoming more feasible to integrate into clinical practice.
Methods: The authors systematically searched seven databases and websites for peer-reviewed and...

The Role of Call-Back Systems in Older Patients Discharged from the Emergency Department

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: UC Irvine in partnership with CipherHealth has incorporated an automated call-back system utilizing a Geriatric Emergency Nurse Initiative Expert (GENIE) to follow-up with older patients. This study aimed to discover the most significant concerns older patients have after discharged from the ED, impact of a call-back system, impact of a dedicated GENIE in the follow-up process, and to highlight areas for further research.
Background: Emergency departments (ED) can be challenging to navigate for elderly patients. Geriatric visits to the ED are common and costly for both patients and health systems. Additionally, older patients are more likely to have a longer length of stay, increased complications and worse health outcomes. Over the past decade, there has been increasing efforts to incorporate geriatric specific care in emergency departments. The goal of these programs was to better communicate with older patients regarding their health and reduce recidivism.
Methods:...

Point-of-Care Ultrasound Interpretation of Cardiac Standstill in Children

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: This study seeks to determine the level of inter-observer agreement among Pediatric Emergency Medicine (PEM) physicians when interpreting POCUS for cardiac standstill in pediatric patients during cardiac arrest as well as highlight factors that may contribute to lack of agreement.
Background: Use of point-of-care ultrasound (POCUS) to diagnose cardiac standstill and guide continuation of cardiac resuscitation has gained widespread use in adult patients and is becoming more prevalent in pediatric patients. Previous studies have demonstrated moderate inter-observer agreement among physicians using POCUS to diagnose cardiac standstill during cardiac arrests in adult patients. There is limited data regarding POCUS interpretation of cardiac standstill among pediatric patients during cardiac resuscitations.
Methods: A single, nation-wide, cross-sectional, convenience sample survey was administered to PEM attendings and fellows between Feb - Jun of 2021. PEM...

Impact of Shared Visits with Midlevel Providers or Residents on Resource Use and Admission Rate

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: To validate and expand upon prior data suggesting that visits shared with a midlevel or resident influence EP behavior as measured by resource use and propensity to admit a patient.
Background: Variability exists in Emergency Physicians’ (EP) resource utilization as measured by ordering practices, propensity to admit patients, and whether a visit is shared with a resident or midlevel provider (nurse practitioner or physician assistant).
Methods: This is a retrospective study of routinely gathered operational data from two community, suburban hospitals within an academic emergency network. We analyzed 34 EPs with 141,433 patient visits from July 1, 2016 to June 30, 2019. We collected individual EP data on advanced imaging (CT, US, MRI), admission rates, and whether a visit was shared with a midlevel or resident for each patient encounter. To investigate whether there might be distinct groups of practice patterns relating these resources, we used a Gaussian...

Patterns of SSRI Exposures Reported to the U.S. Poison Centers

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: We sought to characterize the SSRIs exposures reported to the U.S. National Poison Data System (NPDS).
Background: More than 20 million antidepressants were prescribed between October and December 2020, a significant increase compared to the same months in the prior year. In 2017, a selective serotonin reuptake inhibitors (SSRIs) was mentioned in 57,254 single-substance toxic exposures reported to United States poison centers (PCs).
Methods: The NPDS was queried for all human exposures to SSRIs reported to the U.S. Poison Centers (PCs) between 2015 and 2020. We descriptively assessed the demographic and clinical characteristics. Calls from acute care hospitals and hospital based EDs (ACH) were studied as a subgroup. Trends in SSRI exposures were analyzed using Poisson regression with percent changes being reported.
Results: There were 346,082 SSRI exposure calls made to the PCs from 2015 to 2020, with the number of calls increasing from 51,791...

Serious Medical Outcomes due to Single Substance Opioid Exposures

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The present study sought to evaluate the recent trends in the severe outcomes to single substance opioid exposures (SSO) reported to the U.S. poison centers (PCs).
Background: Misuse of prescription opioids continues to be a significant public health crisis globally. According to the Centers for Disease Control and Prevention (CDC), there were more than 72,000 overdose deaths in the United States (U.S.), with 49,068 involving an opioid.
Methods: The NPDS was queried for single substance opioid exposures that were reported to the U.S. PCs from 2011 to 2011. Cases with severe outcomes (SO) were defined as exposures that resulted in either a death or major clinical outcomes. We identified and descriptively assessed the relevant demographic and clinical characteristics. Poisson regression models were used to evaluate the trends in the number and rates (per 100,000 human exposures) of single substance opioid exposures resulting in SO. Percent changes from...

Variation of Emergency Medicine Resident Productivity During the COVID-19 Pandemic

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: The purpose of this study is to determine Emergency Medicine (EM) resident productivity (as measured by patients per hour) over the course of the COVID-19 pandemic compared to the prior training environment.
Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted medical education throughout the United States. As a result, many EM residents began residency with atypical clinical experiences. In addition, Emergency Department (ED) patient volumes decreased during the early months of the pandemic.
Methods: This is a retrospective observational cohort study conducted at an urban, academic medical center with an established EM residency program. Data was collected from electronic medical records between July 1, 2017 and October 31, 2021. EM residents completing full, consecutive years of residency were included in the sample. Classes prior to 2020 were defined as a control group. Due to the structure of the residency, only shifts at the academic...

Modeling Advanced Practice Provider Productivity in the Emergency Department

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: In this study, we examine APP productivity to determine if a similar pattern applies to that of residents and attendings, with the hypothesis that hourly productivity decreases after the first few hours of the shift.
Background: APP productivity follows a similar pattern to previously described behaviors in both residents and attendings. This further confirms the results of prior studies that productivity is a dynamic process that needs to be considered when adjusting staffing models. Additionally, this pattern by APPs at a community hospital provides additional validation of this model outside of academic institutions or training environments.
Methods: This is a retrospective cohort study from 7/1/21 through 6/30/21 at a single suburban community hospital in the northeast. APPs work ten hour shifts from 10AM to 8PM, nearly every day. APPs also provide coverage for approximately 5 shifts per month from 3PM to 11PM. Timestamps of initial patient contact...

ICU admission Risk Factors of Latinx/Hispanic COVID-19 patients at a US Mexico Border Hospital

Sun, 18 Sep 2022 00:00:00 +0000

Objectives: To describe the association of demographics of sex, comorbidities, age with the risk of severe (Coronavirus Disease 2019) COVID-19 requiring intensive care unit level of care, and death in a primarily Latinx/Hispanic U.S.-Mexico border hospital operating at surge capacity.
Background: According to the CDC, the Latinx/Hispanic population in the U.S. have been particularly affected by severe COVID-19 complications and high mortality rates. Border hospitals and their emergency departments (ED) are particularly vulnerable to widespread communicable respiratory infections and severe COVID-19 complications and poor outcomes such as surges of hospitalizations and death. Multiple factors such as inadequate healthcare infrastructure in border areas, access to preventative healthcare and subsequently higher prevalence of comorbidities that increase the risk for severe COVID-19 in the Latinx/Hispanic patient population overall. At the U.S.-Mexico border region, there...

Emergency Nurses’ Perceptions of Opioid Use Disorder and Its Treatment in the Emergency Department

Wed, 14 Sep 2022 00:00:00 +0000

Objectives: To describe the knowledge and attitudes of emergency nurses regarding caring for patients with opioid use disorder in the emergency department.
Background: Many eligible patients with opioid use disorder do not receive available emergency department services for treatment and harm mitigation. While prior study examined contributing provider factors, little is known of nursing factors. This study describes knowledge and attitudes of emergency nurses regarding patients with opioid use disorder and their evidence-based treatment services in the emergency department setting.
Methods: Anonymous email surveys with novel and previously validated questions based on The Theory of Planned Behavior Framework were distributed to emergency department nurses at a large, urban tertiary-care hospital. Chi-Square and independent samples t-tests were used in analyses.
Results: More than one third of nurses completed the questionnaire (39%, 85/218). Most showed willingness...

Efforts to Diversify Faculty Within Emergency Departments: A National Survey of Department Heads

Wed, 14 Sep 2022 00:00:00 +0000

Objectives:1. To determine how diverse are emergency departmental faculty nationally 2. To determine what modalities emergency medicine department faculty are utilizing to achieve diversity within their departments 3. To determine how effective those modalities have been in achieving diversity in emergency medicine departments
Background: There has been a growing amount of evidence that clinician bias, racism, inequality, stereotyping, and discrimination has indeed contributed to health inequities. These variables have been proven to have negative effects on patient care and health outcomes. Countless studies have shown that diversifying the physician workforce can produce better patient outcomes and decrease the number of health disparities. Patients are more likely to communicate a higher level of care satisfaction when treated by health professionals who share the same racial, ethnic, or cultural background as them. Although many health centers, hospitals,...

Implementation of Vertical Split Flow Model for Patient Throughput at a Community Hospital Emergency Department

Wed, 14 Sep 2022 00:00:00 +0000

Objectives: The objective of this study was to evaluate the impact of vertical split flow (VSF) implementation on emergency department (ED) patient length of stay (LOS) and throughput at a community hospital.
Background: Hospitals have implemented innovative strategies to address overcrowding by optimizing patient flow through the ED. Vertical split flow (VSF) refers to the concept of assigning patients to vertical chairs instead of horizontal beds based on patient acuity.
Methods: This was a retrospective cohort study of all emergency severity index (ESI) level 3 patients presenting to a community hospital ED over a three month period before and after VSF implementation between 2018 and 2019. A vertical area with 10 chairs was separated from the existing ED space and staffed by reassigned advanced practice providers. On arrival, ESI level 3 patients were assigned to the vertical area if they could maintain sitting position during treatment, did not require cardiac...

Medical Simulation Training on Trauma-Informed Care in the Emergency Department

Tue, 6 Sep 2022 00:00:00 +0000

Learning Objectives: To describe a novel simulation training developed to teach Trauma-Informed Care principles and applications for patient care in Emergency Medicine. To present results from pre- and post-surveys about effectiveness of simulations to learn and apply Trauma-Informed Care in acute-care settings.
Introduction/Background: Emergency Medicine physicians often care for patients experiencing direct sequelae from traumatic events including abuse, discrimination, and violence. Trauma-Informed Care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and aims to minimize retraumatization. Limited curriculum on TIC in acute-care settings exists despite its widespread utility, with medical simulations (SIM) presenting a novel educational opportunity for this aim.
Educational Objectives: Describe principles of TIC and its importance in clinical practice. Present strategies for performing TIC-guided history taking and...

Residents’ Perception of the Feedback They Receive

Tue, 6 Sep 2022 00:00:00 +0000

Learning Objectives: Understand what residents perceive as obstacles to receiving feedback. Understand the areas in which residents want more feedback.
Objective: Feedback is perhaps the most important part of the educational process and how residents learn the art and the practice of medicine. Because of its importance, residency programs and all faculty members should constantly strive to improve the process. We sought to analyze the areas our residents believed they could use more feedback and what they perceived as obstacles to obtaining productive feedback.
Methods: Using an online, anonymous survey, all the residents in a 3-year emergency medicine residency program were asked about the feedback they receive. They were asked about the areas in which they receive the most feedback, the areas in which they would like more feedback, and what they perceive as the obstacles to getting good feedback.
Results: 94% of residents said they would like more feedback...

Improving Physician Well-Being and Reducing Burnout Using a Peer-to-Peer Recognition Program

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The objective of our study is to utilize a peer-to-peer recognition program to reduce burnout and improve well-being in our residency program by demonstrating a 10% increase in the Stanford Professional Fulfillment Index (PFI) after participating in this program for 6 months.
Introduction/Background: Physician burnout is a well-known phenomenon and is a work-related syndrome driven by an intricate interplay between healthcare organizational structures, societal influences, and individual level factors. Burnout has been labeled to be a public health crisis and reported to be as high as 70% amongst Emergency Medicine (EM) residents. Given that burnout can lead to an increase in substance abuse, physical/mental health issues, and professional attrition, interventions that can help decrease this phenomenon are imperative. In the traditional workforce, peer-to-peer recognition programs have shown great success in reducing burnout by building a sense of...

Impact of Faculty Incentivization on Completed Resident Evaluations

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Understand alternative methods to increase faculty submission of resident end-of-shift evaluations by incorporating this metric into the faculty incentive compensation plan.
Background: In the Program Requirements for Graduate Medical Education (GME) in EM, the Accreditation Council for GME states “Feedback from faculty members in the context of routine clinical care should be frequent.” It is a common challenge for program leadership to obtain adequate and effective summative evaluations. Previous attempts at our institution to increase feedback have had limited effect.
Objectives: Department leadership hypothesized that linking completed evaluations to the faculty incentive compensation plan would increase the quantity of evaluations.
Methods: This is a retrospective, case-crossover interventional study conducted at an academic tertiary level 1 trauma center and primary EM residency teaching site. At the start of the 2021 fiscal year...

Amazing & Awesome: Incorporating Positive Case-Based Discussion in Emergency Medicine Residency Curriculum to Improve Learning and Team Morale

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: 1. Discuss and analyze cases with exemplary team performance using root cause analysis and case reflection. 2. Demonstrate the importance of clinical learning opportunities from successful cases in medical education (Safety-II Thinking). 3. Value positive clinical cases to boost team morale
Introduction: While M&M has long been part of residency training, few programs dedicate time to highlight above-and-beyond patient care. With this learning gap identified, the Amazing and Awesome (A&A) didactic series was created and implemented. While Saves-of-the-Month awards recognize exemplary care, A&A provides a deeper inspection of the cases. Literature review of other programs with A&A focused on reframing the culture of medicine from Safety-I thinking (reacting to errors) to Safety-II thinking (learning from resilient systems and successful interventions). Currently, there is no data available to assess its perceived value by residents...

Use of Virtual Reality for Teaching Procedures

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The objective of this innovation is to provide virtual reality as an alternative method for learners in emergency medicine to build procedural competence. We will also be looking at feasibility of VR for education and participant satisfaction.
As part of a wider virtual reality curriculum, we are developing and assessing the feasibility of using virtual reality as an alternative method for learners to build competence in procedural skills. This innovation is being tested and implemented with medical students rotating through on their 4th year emergency medicine elective. The study’s plan is to look at how practicing procedures with virtual reality compares to more traditional hands-on simulation techniques. Medical students were given a lecture on how to do a surgical chest tube. Then, depending on the month, students were either assigned to practice with virtual reality programs or with simulation task trainers. The following week students were assessed...

Reducing Electronic Health Record (EHR) Click Fatigue: An Innovative Approach to Common Order Sets

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Our initiative aims to develop an education innovation that contributes to: • Enhancing EHR usability through facilitating the process of placing medical orders. • Decreasing click fatigue while increasing professional satisfaction among emergency medicine residents.
Introduction/Background: Bureaucratic tasks are the leading cause of burnout among emergency medicine physicians. Among those tasks is placing medical orders in the Electronic Health Record (EHR), which is a time-consuming and rigorous process that can lead to click fatigue and increase physician burnout. Therefore, we believe that optimizing the EHR experience for order placement will not only decrease the amount of time spent using the EHR but will also decrease click fatigue and improve overall satisfaction of emergency medicine physicians.
Curricular Design: We designed a PowerPoint educational module for the emergency medicine residents that guides them through the process...

Value Transformation through Process Mapping- An Idea Generator for Resident led QI Projects

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Review fundamental principles in high-value care Develop a list of opportunities to optimize value based care in the ED Introduce Value Process Mapping to explore barriers to high value care.
Introduction/Background: Quality Improvement (QI) is a key component of resident education and an ACGME requirement. Despite being on the front lines and witnessing low value care on a regular basis, many residents struggle to complete robust QI projects throughout residency. A key barrier to resident participation in QI projects is inexperience and poor understanding of the key components of QI. We developed a two-hour course that stresses individual thought and hands-on expert guided experience to empower residents to start their own meaningful QI projects.
Curricular Design: An expert in value based care led two 1-hour sessions to teach our residents components of QI and review key principles of our institutions transition to value based care: Care Variation,...

Self-Compassion Predicts Intolerance of Uncertainty: A New Construct to Prepare Students for Clinical Uncertainty

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Managing uncertainty represents a significant source of stress for clinicians and trainees. Self-compassion is a strategy to help individuals cope with stress. The objective of this study is to determine the relationship between intolerance of uncertainty and self-compassion in medical students.
Background: For clinicians, higher scores on the Intolerance of Uncertainty Scale (IUS) have been linked with failure to comply with evidence-based guidelines and higher likelihood of burnout. In contrast, higher self-compassion scores are correlated with decreased stress and burnout. A negative correlation between self-compassion and intolerance of uncertainty has been demonstrated in college students and general population. This relationship has not been examined in medical students and provides a possible curricular aim for addressing stress as they transition to clinical learning environments during clerkships.
Objectives: The goal of our study is...

The Impact of On Shift Evidence Based Medicine Activity on Patient Care

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: This project seeks to describe how on shift EBM activity by EM residents impacts clinical patient care.
Background: Evidence Based Medicine (EBM) skills allow EM providers to obtain and apply new information while on shift in the ED. The impact of using EBM on shift to patient care has not previously been described.
Objective: This project seeks to describe how EBM activity by EM residents impacts clinical patient care.
Methods: This IRB approved study was conducted by a PGY 1-4 EM residency. Residents are required to complete logs of on-shift EBM activity in the program’s procedure software system New InnovationsTM. The logs are a convenience sample, with an N of 3-5 per 28-day EM rotation. The logs include a patient description, clinical question, search strategy, information found, and subsequent application. Using qualitative methodology described by MacQueen (CAM 1998), a codebook was created to analyze resident free text to the prompt:...

The Leaky Pipeline in Emergency Medicine: Understanding Factors Pushing Women Away and Informing Interventions

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Understand the environmental factors which influence selection of Emergency Medicine as a specialty by women medical students.
Background: Women represent 28.3% of EM physicians. There is now gender parity in US medical schools, but women applicants to EM ranges 33-37%. Prior research does not explain these gender differences. There are known differences in resident experiences and assessments based on gender.
Objectives: We sought to explore how clinical experiences and perceptions of the specialty influence selection of EM by women.
Methods: Using purposive and convenience sampling to represent diverse learning environments, we conducted semi-structured interviews of men and women US senior medical students who considered EM as a specialty. Interviews were transcribed, de-identified, and coded using constant comparative analysis until saturation. We conducted thematic analysis using a constructivist approach and grounded theory. Reflexivity...

Development of a Rigorously Designed Procedural Checklist for Emergent Cricothyrotomy for Assessment of Emergency Medicine Resident Performance

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The objective was to create an assessment tool for emergent cricothyrotomy using best practice checklist development and expert consensus.
Introduction/Background: Emergent cricothyrotomy is an infrequently performed, potentially life-saving procedural skill that is essential for emergency physicians to master during residency training. However, opportunities for real-life exposure to perform this procedure during residency is rare and ensuring emergency medicine graduates can perform this procedure correctly is essential. For rare, invasive procedures such as cricothyrotomy, checklist simulation assessments allowing for objective measures are best practice for competency based medical education. However, the literature for performing emergency cricothyrotomy is descriptive, not inclusive of evaluative checklists, and lacking a checklist that allows for multiple cricothyrotomy techniques.
Educational Objectives: The objective was to create an assessment...

White Coat Study: Gender Bias in Emergency Medicine

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Assess the prevalence of self-reported gender bias in EM physicians and strategies in personal care and appearance that are used to overcome them.
Background: Female and nonbinary (NB) emergency medicine (EM) physicians experience gender discrimination. We have limited data regarding how female and NB physicians overcome daily workplace barriers. Gender differences in attire and grooming may be part of a physician’s efforts to be appropriately credited as a physician by their patients.
Objectives: Assess the prevalence of self-reported gender bias in EM physicians and strategies in personal care and appearance that are used to overcome them.
Methods: This is an ongoing cross-sectional survey study of EM physicians at a representative sample of eight emergency departments across the U.S. Sites have been selected to represent diverse practice environments. An anonymous survey was developed through expert consensus and distributed electronically...

A National Survey of Emergency Medicine Medical Education Fellowship Directors: Roles, Responsibilities, and Priorities

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The goal of this study is to characterize the roles, responsibilities, and support for MedEd fellowship directors.
Introduction: Despite Medical Education (MedEd) Fellowships increasing in number, the position of MedEd fellowship director remains poorly defined.
Methods: We developed and piloted an anonymous electronic survey, consisting of 32 Likert-type and free response items, that we distributed via the CORD MedEd Fellowship Community of Practice listserv. We used descriptive statistics to analyze data from items with discrete answer choices. Chi-squared testing was used to evaluate differences between programs. Using a constructivist paradigm, we performed a thematic analysis of free response data.
Results: Thirty-five of 44 MedEd fellowship directors (80%) completed the survey. Thirty-seven percent of respondents were female (13/35). Fifty-one percent earned Master’s degrees in education and 37% completed a MedEd fellowship. Many...

Effectiveness of a collaborative, virtual outreach curriculum for 4th year EM-bound students at an HBCU

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: We sought to 1) teach the approach to core complaints in EM, 2) teach key skills in EM, 3) de-mystify the process of applying to an EM residency program, and 4) connect students with residents and faculty in the field of EM.
Introduction/Background: Despite having a diverse patient population, emergency medicine (EM) remains among the medical specialties with the lowest number of residents and attendings underrepresented in medicine (URiM). Increasing awareness of the field of EM in medical schools that are affiliated with Historically Black Colleges and Universities (HBCUs) is one way to increase the pipeline of URiM in EM. Currently, however, there are zero HBCUs with academic emergency medicine departments. As representatives of four departments of EM, we partnered with one HBCU to attempt to fill this gap for EM-interested students on their 4th year EM home rotation.
Educational Objectives: We sought to 1) teach the approach to core complaints...

Task Trainer Augmented Joint Reduction Training

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: To investigate whether augmenting joint reduction education with 3D printed task trainers will offer a learning benefit when paired with traditional teaching methods using lectures and videos. The application is focused on EM residents with potential expansion to surgical subspecialties.
Introduction: Prior studies and EM training programs have called for the need for innovation in the realm of orthopedic education. When compared to other core skills developed during EM residency, joint reductions are relatively infrequent. The development of 3D printing technology offers an opportunity for the development of task trainers to supplement resident experience. There are no current 3D printed task trainers available for joint reductions. We developed a series of 3D printed joint models with orthopedic curriculum to supplement exposure to dislocation reductions to improve emergency medicine residents’ preparedness, confidence, and competency in joint dislocation...

Guided Imagery: An adjunct to teaching central venous access

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Introduce guided imagery as a novel approach to education and simulation in graduate medical education.
Background: Guided imagery is commonly used in sports psychology for post-injury rehabilitation, rep-max movements, and muscle activation as part of a multifaceted approach to learning. Utilization of guided imagery combined with traditional teaching may provide an innovative and comprehensive approach to graduate medical education.
Objectives: To show greater proficiency in medical students’ ability to obtain central venous access in simulation trainers following exposure to guided imagery teaching methods in comparison to traditional methods.
Methods: Auditioning fourth year medical students were offered the opportunity to participate. They were randomly assigned to two groups, traditional teaching or guided imagery teaching. The traditional teaching group watched a video using traditional methods. The guided imagery group watched...

Perspectives in Post-Pandemic Employment for Emergency Medicine Trainees

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: To survey graduating EM residents on their perceptions of the EM job market and its effect on their desire to pursue fellowship training.
Background: The COVID-19 pandemic has resulted in changes to the emergency medicine (EM) workforce which pose challenges to residents graduating from EM training programs. New graduates face increasing uncertainty in the search for their first job. EM graduates in 2020 and 2021 saw a notable decrease in opportunities compared to years prior. ACEP’s Workforce Study (April 2021) predicts a surplus of emergency physicians by 2030. Objectives: To survey graduating EM residents on their perceptions of the EM job market and its effect on their desire to pursue fellowship training.
Methods: We surveyed senior residents (PGY2 and above) at three- and four-year EM residency programs in the greater NYC area. Paper surveys were mailed out to each of the programs with a return envelope; a virtual link to complete...

Implementation of a Dedicated Social Worker/Coach for Emergency Medicine (EM) Residents

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The pandemic exposed the mismatch between trainee mental health needs and their access to support services; therefore, the objective of our innovation was to support an opportunity for residents to work with a social worker/coach who could provide coaching on an emergent, urgent, or regular basis.
Introduction/Background: EM training requires sleep-wake disruptions, includes potentially traumatizing encounters, all during the COVID-19 pandemic while many residents relocate away from their customary psychosocial supports for training. The shift-based training model limits access to psychosocial care and services, so trainees need just-in-time resources which can support them before mental health concerns develop.
Educational Objectives: The objective of our innovation was to support an opportunity for our residents to work with a professional social worker who could provide coaching on an emergent, urgent, or regular basis.
Curricular Design:...

Teaching Palliative Care to Emergency Medicine Residents Using Deliberate Practice-Based Simulation Format: LIVE DIE REPEAT

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: 1. Recognize a new format to teach end-of-life care. 2. Review the perception of learners using a serious-game framework to learn rapid discussion about goals of care.
Introduction: Emergency departments (ED) care for many patients who are chronically ill and nearing end of life. Establishing goals of care and code status in the ED is an essential skill for Emergency Medicine (EM) residents but is challenging to teach.
Educational Objectives: To develop EM residents’ ability to: 1) identify patients in need of a goals-of-care discussion; 2) interpret advance care planning documents; 3) efficiently conduct an informed code status discussion; and 4) manage the actively dying patient.
Curricular Design: High-fidelity simulation was utilized to replicate the experience of caring for a critically-ill patient in the high-stress ED environment. The scenario involved a live standardized patient with stage 4 pancreatic cancer presenting with sepsis...

The Social Emergency Medicine Mini-Curriculum: A Novel, Multifaceted Immersive Approach to Resident Education in Social EM

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: 1) To design, implement and evaluate the feasibility of a replicable multifaceted Social EM curriculum for EM residents 2) To increase EM residents’ level of awareness related to Social EM and increase their ability to identify/intervene on social determinants of health in clinical practice
Background: Emergency Medicine (EM) physicians are in a unique position to impact both individual and population health needs. Despite this, EM residency training lacks a formalized education on social determinants of health (SDoH) and social EM (SEM). The need for such a curriculum has been previously recognized, however there is a gap in the literature related to the feasibility of such a curriculum addition. This innovation seeks to address this need.
Curricular Design: A taskforce of EM clinician-educators with expertise in SEM developed a 4.5-hour educational curriculum for use during a single Emergency Medicine resident didactic block (1/2-day session)....

Towards an Explanatory Framework of Informal and Incidental Learning in Medical Education: A Deductive Analysis of Critical Incidents from Frontline Physicians Working During the COVID-19 Pandemic

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.
Background: Informal learning is implicit, organic, and unstructured. Opportunities for informal learning arise in ill-structured, unstable environments where established processes may fail to provide a means of understanding situations or to develop strategies to problem-solve. We examined the Marsick and Watkins Model of Informal and Incidental Learning (IIL) as a framework to describe how physicians learn in the clinical environment, particularly when working through heightened uncertainty.
Objective: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.
Methods: A qualitative deductive analysis of physicians’ narratives using the critical incident...

What Is a Wellness Chief?

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The objective of this project is to develop and distribute a Chief Wellness Resident (CWR) Playbook to clarify the responsibilities of the CWR in order to improve wellness outcomes at both the GME and UME level.
Introduction: In 2018, in response to resident suicides and physician burnout, the ACGME implemented wellbeing requirements. Since then, chief wellness residents (CWRs) have become increasingly common, but their responsibilities and purposes remain nebulous.
Educational Objectives: Two EM CWRs (Cook County Hospital and the University of Iowa) met to discuss the development of a CWR Playbook with the following objectives: 1) outline the role of the CWR and 2) identify resources that a CWR needs to be successful.
Curricular Design: CWR Playbook Sections. 1. Wellbeing Requirements: The ACGME outlines residency program wellness requirements and unwellness mitigation (e.g., depression, suicidal ideation, addictions, fatigue). The CWR...

Time to Dust Off Your Passport: A Roadmap to Enhance Your Path to the EM Workforce

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: The goal of this project was to promote early professional and clinical development of residents by creating a well-organized, visually-appealing roadmap of co-curricular requirements to augment resident training and provide a well-rounded residency experience.
Background: With the rapid growth of EM as a specialty and an increasing number of accredited residency programs, EM has become increasingly more competitive. EM physician workforce projections are daunting, particularly to current and future trainees. The prospect of securing a desirable and fulfilling job after residency is becoming exceedingly more uncertain, even with fellowship training. While there are evolving larger-scale initiatives to address this, an onus falls on individual trainees and their residency programs to improve resident skillset and marketability.
Curricular Design: Core faculty from various EM subspecialties proposed unique learning experiences within their respective...

Resident-Led Wellness Program

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: 1) Anonymously survey residents to obtain rates of burnout and identify gaps in resident wellness. 2) Create a resident-led, self-sustaining wellness committee 3) Integrate wellness education into a formal grand rounds curriculum 4)Reduce self-reported resident burnout rates.
Introduction/Background: Residents suffer from numerous stressors that lead to poor mental health and significant rates of burnout. The Madigan Army Medical Center Emergency Medicine (EM) residency program had aspects of wellness built into its program but lacked a formal wellness curriculum or internal evaluation system.
Curricular Design: To address the lack of formal wellness resources, anonymous surveys were sent to residents, a formal wellness curriculum developed, and a resident-led wellness committee was formed. Following an introductory wellness lecture, residents were anonymously surveyed to assess knowledge of local wellness resources, rates of burnout, and gaps...

Improving Student Documentation in the Emergency Department

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Demonstrate a curriculum designed to teach medical students how to successfully write the medical decision making portion of the emergency medicine note.
Introduction: Documentation is an essential component of patient care in the emergency department (ED). Although students are taught the general rules of note-writing prior to clerkships, the emergency medicine (EM) note differs from most rotations. There is a need to teach the specifics of documentation of the EM note to medical students. The Emergency Medicine Residents’ Association (EMRA) Education Committee created a curriculum to teach formal documentation to medical students.
Educational Objective: Create a curriculum designed to teach medical students how to successfully write the medical decision making (MDM) portion of the EM note.
Curricular Design: Our curriculum design assumes that all senior medical students were taught the basics of writing a history and physical. Therefore,...

Virtual Peer Support Program: A Novel Community-Building Platform in an Emergency Medicine Residency Program

Mon, 29 Aug 2022 00:00:00 +0000

Learning Objectives: Our Virtual Peer Support Program aimed to enhance residents’ comfort engaging in discussions about their workplace challenges and foster a sense of community within the residency program.
Introduction: Burnout is highly prevalent in resident physicians and is associated with depression, substance use, and suicide. While residents’ social networks are integral in supporting wellness, the recent pandemic has limited in-person social support, potentially exacerbating residents’ existing burnout and increasing barriers to communication. As such, we sought to implement a Virtual Peer Support Program (VPSP) within our residency program to provide a safe space for residents to discuss the work and life challenges they encounter during residency training. Our VPSP aimed to enhance residents’ comfort engaging in discussions about workplace challenges and foster a sense of community within the residency program.
Design: During the 2020-2021 academic year,...

CORD Abstracts Special Issue

Thu, 25 Aug 2022 00:00:00 +0000
CORD Abstracts Special Issue

Beyond ACLS: Training your novice resuscitationist for cases when the patient does not follow the algorithm

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To train Emergency Medicine residents how to properly and safely handle complex scenarios that require resuscitation outside the normal Advanced Cardiovascular Life Support (ACLS) algorithm using peri-code algorithms using both high and low fidelity techniques.
All Emergency Medicine residents get basic training running a code during their ACLS certification in the United States. However, there are not many easily applicable and accessible courses that provide comprehensive detailed training on peri-arrest scenarios. Beyond ACLS is a 1-day training course that took place in our simulation center. Residents were first given a questionnaire regarding their confidence and knowledge on scenarios that may require them to deviate from the ACLS algorithm. Residents were subsequently split into groups of three, each consisting of an intern, junior and senior resident. The intern was responsible for airway, the junior was running the resuscitation and the...

The Impact of an Experiential Social Medicine Curriculum in a County Emergency Medicine Residency Training Program

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To evaluate the effect of an Experiential Social Medicine Curriculum on residents’ attitudes, perceived responsibility and competence towards vulnerable populations.
Introduction: Social Medicine (SM) is an emerging field that includes the study of the social determinants of health. Despite widespread acknowledgement of its influence in patient care, SM is underemphasized in graduate medical education. Attempts to incorporate SM into residency curricula have shown promising results, though the impact of SM curricula on emergency medicine (EM) residents remains unclear.
Objective: We developed a experiential SM elective for residents and evaluated the impact of the curriculum on residents’ attitudes toward and care of vulnerable populations.
Curricular Design: In 2018-2019, all residents at our EM Residency Program were invited to participate in a two-week SM experiential elective focused on patients experiencing substance use disorders,...

Developing a Longitudinal Cultural Competency Curriculum

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Enhance EM resident cultural competence through the acquisition of knowledge, skills, and attitudes to effectively care for all patients. Objectives were developed using Bloom’s taxonomy for each module within the curriculum.
Background: Training has been found to improve knowledge of cultural and behavioral aspects of healthcare and build effective communication skills. To the best of our knowledge, this is the first longitudinal cultural competency curriculum to be studied in EM residents.
Objectives: Enhance EM resident cultural competence through the acquisition of knowledge, skills, and attitudes to effectively care for all patients. Objectives were developed using Bloom’s taxonomy for each module within the curriculum.
Curricular Design: Learners are 18 EM interns at a single urban 3-year program. Our 12-month curriculum was developed using Kern’s 6-step model. A general needs assessment was conducted via literature search and consultation...

A day in the life of an emergency department (ED) patient: In-situ ED patient experience simulation for emergency medicine interns

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: The purpose of this educational innovation was to examine first year emergency medicine resident (EM-1) perspectives on the ED patient experience and examine how EM-1 empathy may change after experiencing a simulated ED encounter.
Introduction/Background: Empathy is an essential trait for compassionate physicians and the importance of a positive patient experience in the emergency department (ED) is being increasingly emphasized. Currently, there is no best practice guidelines as to how to educate emergency medicine residents about patient experience.
Curricular Design: During the first week of EM-1 orientation, 12 residents at a community academic emergency medicine residency program consented to serve the role of patient, family member or observer. In groups of three, EM-1s navigated through four simulated ED encounters in their assigned role (left arm weakness, suicidal ideation, dyspnea, eye pain). Those role-playing as patient or family...

Teaching and Assessing Bag Valve Mask Ventilation to 4th Year Medical Students via Checklist

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Create a checklist that is expert reviewed to teach BVM to 4th year medical students. Implement a curriculum to teach using the checklist and then assess performance with high-fidelity simulation.
Introduction: Bag-valve-mask ventilation (BMV) is an essential skill to master when teaching medical students basic airway management. Standardized checklists help teach and assess learners. A validated checklist for teaching BMV to medical students does not exist in the literature. Current standards typically involve teaching learners BMV skills on mannequins in static situations.
Educational Objective: Create a checklist that is expert reviewed to teach BVM to 4th year medical students. Implement a curriculum to teach using the checklist and then assess performance with high-fidelity simulation.
Curricular Design: A previously published checklist was improved upon using expert consensus of 10 EM and 10 anesthesia faculty. A 2-handed technique...

Case-Based Curriculum for Assessing Decision Making Capacity in the ED

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: The goal of this curriculum is to provide emergency medicine residents a framework for assessing decision making capacity in the ED and apply these skills to several case scenarios to practice making nuanced capacity decisions.
Introduction: In the ED, physicians often meet patients for the first time during critical, time-sensitive situations. The ability to quickly and effectively assess decision making capacity is a crucial skill. We are unaware of any formal curricula about assessing decision-making capacity tailored to the challenges faced in the ED. Thus, we designed a curriculum to provide EM residents a framework to evaluate decision-making capacity.
Educational Objectives: By the end of this workshop, EM residents should be able to: -List the four elements of a capacity assessment -Apply these four elements to specific cases to assess a patient’s capacity -Differentiate between functional status, capacity and competency.
Curricular...

Preparing for Discharge: A Workshop on Communicating Diagnostic Uncertainty

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Demonstrate a workshop designed to teach third year medical students how to communicate diagnostic uncertainty.
Background: Diagnostic uncertainty abounds in medicine. Effectively communicating that uncertainty is critical to high-quality patient care. There is a gap in training preparing medical students for communicating diagnostic uncertainty. The Uncertainty Communication Checklist (UCC) is a framework to effectively communicate diagnostic uncertainty to emergency department patients at discharge.
Educational Objectives: We developed a workshop to address a curricular gap in preparing medical students to communicate diagnostic uncertainty to patients. Its objectives were to introduce learners to diagnostic uncertainty, discuss the importance of effective communication during times of diagnostic uncertainty, describe key steps for effectively communicating uncertainty, and practice communication through peer role-play.
Curricular Design:...

A Comprehensive Approach to Increase Emergency Medicine Resident Involvement in Caring for Opioid Use Disorder

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To train EM residents to: •Screen and identify patients with OUD •Manage OUD by implementing evidence-based practices in EM, including initiating buprenorphine for patients in moderate to severe withdrawal •Support the transition of patients with OUD to long-term care for ongoing treatment.
Introduction: Opioid use disorder (OUD) is a chronic medical condition with alarming repercussions, including death and disability. Although, healthcare organizations, nationwide, have launched multiple initiatives to put an end to this epidemic, deaths related to opioids continue to be on the rise. More specifically, initiatives that involve abstinence have been shown to be less effective and are associated with high rates of relapse, including detoxification, rehab, 12-step programs, and Narcotics Anonymous. Medications for Opioid Use Disorder (MOUD), however, seems to be a promising approach to achieve recovery and reduce relapse. Our institution received a...

Gotta Escape EM all! Emergency Medicine Resident Education with Gamification

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Priapism drainage; Common causes of hyperkalemia; Pacemaker EKGs and errors; Common toxic botanicals and their treatments; Beta-blocker toxicity management; Psychiatric medical emergencies; Resuscitation of adult and pediatric burn victims; Wilderness resuscitation skills.
Introduction/Background: Traditional conferences provide a uniform, didactic review. Modern residents can benefit from a structure that engages them in active learning with immersive and collaborative experiences. Activities like flipped classrooms, simulation, and virtual learning have improved upon the ennui of prior conferences. We seek to appropriate the escape room to review key, uncommon topics in emergency medicine (EM) as a conference activity to address areas of improvement in residents’ knowledge prior to their in-training exam (ITE).
Educational Objectives: At the completion of the escape room activity, residents and medical students will be tested upon and be able...

Unmasking the Impostor Phenomenon in First-Year Residents

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objective: To determine the prevalence of IP and related attitudes in first-year residents.
Background: Impostor phenomenon (IP) is an experience in which individuals attribute their success to external factors and maintain a fear of exposure as a fraud. Times of transition are particularly high-risk for IP. Encouraging reflection and conversation about professional identity and self-doubt may decrease IP in first-year residents.
Objectives: To determine the prevalence of IP and related attitudes in first-year residents.
Methods: This was a prospective mixed-methods study conducted in July 2021. 63 first-year residents (47 EM, 16 FM) from 3 institutions participated in a session on IP during orientation: a formal lecture and reflective activity in which learners painted masks representing their internal and external selves and shared reflections with peers. Prior to the session, learners completed the Clance Impostor Phenomenon Scale (CIPS) and free-text...

Inter-physician conflict in the workplace: an under-explored contributor and manifestation of burnout

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objective: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being.
Background: Despite the recognized importance of collaboration and communication, interpersonal conflict amongst healthcare providers in different specialties remains a pervasive issue. Recent work elucidated some of the social conditions and processes that contribute to conflict between EM and IM physicians at the time of admission. However, little is known about the consequences that inter-physician conflict has on providers’ well-being.
Objective: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being.
Methods: In this study, the authors used constructivist grounded theory to explore themes related to the impact of conflict on individual providers. A purposive sampling approach was used...

A Novel Social Emergency Medicine Curriculum: An Alternative to Lecture-Based Didactics

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: We sought to create a Social EM rotation to improve residents’ understanding of structural vulnerability, health inequity, and social determinants of health and improve their ability to address barriers to care and social needs in the emergency department.
Introduction: Social determinants play an important role in patient health. While many Emergency Medicine (EM) residency programs agree that Social EM is an important component of education, few programs have formal curricula addressing Social EM. Social EM education varies widely from program to program.
Objective: We sought to create a Social EM rotation to meet the needs of EM residents. This rotation would allow dedicated time to learn Social Medicine skills and familiarize residents with hospital and community resources. The main objective is to improve residents’ understanding of structural vulnerability, health inequity, and social determinants of health and improve their ability to...

Learning Silos: Are we adequately preparing our residents for clinical practice?

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Audience members will learn how to implement experiential teaching strategies/modalities that diminish learning silos and allow for integrated learning to meet the educational objectives of varying residency requirements (EM milestones, EM boards, and clinical practice).
Introduction: Traditional conference format provides instruction on core EM content to help residents meet EM milestones. Independent board review questions allow residents to practice EM board questions. Clinical practice allows for the application of some EM knowledge to actual patients. However, these learning silos may prevent higher level cognitive integration of EM knowledge to adequately prepare our residents to care for patients in the real world while simultaneously achieving their career milestones.
Curricular Design: Our leadership team developed theme-based experiential conference with an integrated and innovative system for active learning to remove segregated teaching...

Transitions to Life After Residency: A Curriculum for Senior Emergency Medicine Residents

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To understand the value of a senior EM resident curriculum that introduces knowledge and skills for successful navigation through the life and career transitions that occur during the final year of training.
Introduction: The final year of residency is filled with refining clinical skill and knowledge, but also with anticipation of professional and personal changes as residents prepare for the transition to life as an attending. There is existing literature to demonstrate a lack of resident familiarity in several personal and professional skills necessary to navigate life after residency, but there is sparse literature on curricula dedicated to guiding trainees in making a successful transition.
Educational Objectives: To deliver an aptly timed curriculum to senior EM residents with the goal of introducing desired knowledge and skills for successful navigation through the life and career transitions that occur during the final year of training.
Curricular...

Developing Procedure Guides to Improve Procedural Competence and Confidence

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Help resident physicians become experts on procedural competency by developing a peer-reviewed procedure guide.
Introduction: Emergency medicine physicians (EPs) need to perform a broad range of procedures quickly and effectively. While some procedures are common, others are rarely encountered. However, an EP must be ready to perform all these procedures, often with minimal time to prepare. While there are numerous procedural references, not all are reliable or easily accessible on shift. Developing a procedure guide repository would result in a useful clinical and teaching tool. Creating the guide itself will aid in mastery of the procedure.
Objective: Help resident physicians become experts on procedural competency by developing a peer-reviewed procedure guide.
Curricular Design: 73 procedures were chosen for this project. Residents and attendings worked together to create a guide for each procedure. Each pair was given a standardized...

Work for Idle Hands: A Simulation Model for Nail Bed Injury and Avulsion Repair

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Wounds of the fingernail bed are a frequent injury encountered in the emergency department however residents often learn techniques for repair at the bedside. We aimed to develop and evaluate an economical and accessible simulation model of nail bed repair that could be used during online lecturing.
Introduction: Hand and fingertip trauma account for millions of visits to the emergency department annually. Nail bed injuries, including avulsions or unstable nails, are particularly common, however, there are limited opportunities for supervised practice and mastery of nail bed avulsion repair. We developed an economical and accessible simulation model to allow for practice of nail bed avulsion repair during remote lecturing in the early days of the Covid-19 pandemic.
Curricular Design: The model consists of a halved hotdog with an acrylic nail embedded into and glued using nail glue at the terminal rounded end. Pressure was applied to the distal...

Development of an educational experience for medical students on coping with medical errors in residency and beyond

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To design an educational experience for senior medical students that addresses coping with medical errors.
Introduction: Navigating and coping with medical errors, which are inevitable realities of clinical practice, is an important physician competency. While medical students and residents recognize the importance of this topic, medical training programs vary substantially in their approach to teaching about medical error, and many offer no formal instruction in this topic.
Educational Objective: To design an educational experience for senior medical students that addresses coping with medical errors.
Curricular Design: We designed and implemented an educational experience within the established fourth-year capstone course at our institution, which is a required 2-week curriculum that prepares 4th year students for the transition to internship. After a brief lecture on medical errors, students participated in a standardized patient encounter...

Impact of Implementation of Prehospital Run Reviews into Resident EMS Curriculum

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Describe the impact of implementing a longitudinal resident run review process on resident EMS education, specifically ACGME-identified EMS training objectives.
Background: ACGME requires EM residencies provide experience in emergency medical services (EMS), particularly in prehospital medical oversight.
Educational Objectives: To evaluate the impact of a longitudinal resident run review process on resident EMS education.
Curricular Design: Within the residency, senior (PGY-2/3) EM residents participate in 1-2 EMS shifts per month. Discussion between an EM resident and EMS faculty led to the decision to incorporate into a pre-existing on-line EMS follow-up/care feedback request process the option of a formal run review. An outreach nurse received all EMS requests and assigned run reviews to senior residents to be completed during upcoming EMS shifts. Residents were provided patient details and a run review template with the following suggested...

Battle of the Classes: Experiential Learning Through the Gamification of Conference

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: 1) Improve active engagement of learners through gamification. 2) Prepare learners to appropriately respond to mass casualty incidents. 3) Understand the management of multiple disease processes secondary to trauma and environmental factors.
Background: With traditional models of teaching falling out of favor, there is increased evidence supporting hands-on and experiential learning models. Gamification is a dynamic avenue that stimulates learner engagement by incorporating elements of game design to non-game contexts. However, its utility as a learning tool has not been formally examined as part of a residency curriculum. We aim to augment existing learning models by implementing gamification in a SimWars-based conference curriculum.
Educational Objectives: 1) Improve active engagement of learners through gamification. 2) Prepare learners to appropriately respond to mass casualty incidents. 3) Understand the management of multiple disease processes...

Innovative Teaching Format: Environmental Emergencies

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: 1. Create content that varies in teaching format and requires active engagement by a small group of residents for six twenty-minute sessions 2. Teach a variety of environmental disaster medicine topics and their subsequent workup and management
Introduction: We present an Innovative Teaching Format (ITF) focusing on Environmental Emergencies developed during our 2021-2022 academic year at Orlando Health Emergency Medicine Residency Program, an ACGME accredited, Level 1 trauma center. The curriculum was introduced to PGY1-3 residents. Resident assessments were provided pre- and post- ITF.
Curricular Design: ITF: Environmental Emergencies is designed to review six environmental medicine categories, each the focus of 20-minute small group learning sessions. Topics include snake envenomation, altitude sickness, dysbarism, lightning strike, marine envenomation, and hypothermia. Stations are designed with intent to be engaging and require active participation,...

A Deliberate Educational Initiative in Diversity, Inclusion and Racial Equity

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Covering the domains of knowledge, skills and attitudes, residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature.
Introduction/Background: Since the 2003 “Unequal Treatment” report showed that health gaps are not due to access or income, racial injustice and COVID-19 have laid bare worse inequities. In 2021, the ACGME EM Milestones addressed recognition of health gaps and personal bias, however there is no guidance on how to do this. ED patients require an unbiased evaluation to ensure rapid and accurate diagnosis and treatment, but implicit bias reigns with high cognitive load. Thus, we describe a deliberate and formal diversity, inclusion and racial equity (DIRE) curriculum.
Educational Objectives: Residents were expected to analyze structural violence and health gaps, demonstrate...

The Incorporation of a Case-Based Health Equity Curriculum Into M&M Conference

Wed, 24 Aug 2022 00:00:00 +0000
Learning Objectives: To deliver evidence-based health equity education in resident and faculty conference using case-based content to highlight examples of inequity in emergency medicine practice.Background: While GME requires formal education on health disparities, there is a lack of standardized education in emergency medicine (EM) residency curricula on these topics. Educational Objectives: 1. To evaluate health disparities in an evidence-based manner using anonymized ED-specific case examples 2. To increase structural competency regarding the systems that perpetuate these disparities 3. To equip EM providers with actionable steps to mitigate these disparities 4. To develop a curriculum that can be replicated by other programs. Curricular Design: The Health Equity Curriculum (HEC) was developed using Kern’s curricular design framework. A consensus group of residents and faculty members met over 4 months to identify curriculum gaps. Patient and provider-centered topics...

A Novel Curriculum for Reducing Distal Radius Fractures in an Emergency Medicine Residency Program

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: We developed a curriculum using a high-fidelity model for residents to learn proper reduction of closed, stable distal radius fractures without orthopedic consultation.
Background: EM residents are expected by the ACGME to be competent in managing orthopedic injuries. Given that these injuries make up 20% of ED visits, it is essential that residents feel comfortable and competent in managing them. In a recent survey sent to alumni of several EM residencies, more than half of respondents reported feeling not at all or somewhat prepared to independently reduce closed fractures. They also stated seeing wrist and distal radius and ulna fractures most frequently. We also received resident feedback from our own program that they felt uncomfortable reducing these fractures without orthopedic consultation, even though it fell within their scope of practice.
Educational Objectives: We developed a curriculum using a high-fidelity model for residents to...

Implementation of Foundations of Emergency Medicine Cases Through High Fidelity Simulation for PGY-1 EM Residents

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Describe the process of converting “Foundations of Emergency Medicine” cases to high-fidelity simulation scenarios, implement cases for PGY-1 EM, EM/IM, and EM/FM residents, and survey simulation specialists and residents regarding the resources required and the curriculum’s educational value.
Introduction: Foundations of Emergency Medicine (FoEM) is an open-access curriculum that involves case-based table-top exercises, and is an established part of our weekly conference. Case-based simulation has been shown to improve clinical knowledge and comfort levels in the care of critical patients. The educational need for this pilot study arose from PGY-1 residents’ requests for more time to run cases in our simulation center.
Educational Objectives: To convert FoEM cases into high-fidelity simulation cases to enhance PGY-1 residents’ learning experience, and to evaluate the feasibility of the process.
Curricular Design: Simulation specialists...

Online simulation effectively teaches introductory disaster triage skills to medical students

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: To use online simulation to teach disaster triage skills to medical students.
Background: Practicing disaster triage teaches skills of rapid patient evaluation. Triage simulation (with structured debriefing) results in improved accuracy in pediatric residents and improved confidence in medical students. Screen-based simulation of disaster triage improved triage accuracy in prehospital providers, and virtual reality (VR) simulation improved medical student triage skills. Few studies have evaluated online simulation to teach disaster triage skills to medical students.
Design: In May 2021, 15 final-year medical students engaged with online simulation to practice triaging respiratory disease outbreak patients. Students submitted personal reflections and participated in a faculty-led debrief. In October 2021, 9 additional students participated.
Outcomes: 14/15 students completed an anonymous post-course survey. Students found the exercise “very”...

Airway Tape Review: Learning Through Retrospective Review of Video Laryngoscopy Cases

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: With Airway Tape Review (ATR), we sought to implement a curriculum where actual resident airway recordings are reviewed in a group setting. The lecture series highlights best airway practices, challenging cases and common mistakes encountered by learners.
Introduction/Background: Airway Tape Review (ATR) provides a novel approach to covering airway curriculum through real airway cases. The advent of video laryngoscopy has allowed viewing of resident intubation by the supervising attending, improving safety and feedback in real time. Recording these intubations allows for retrospective review, knowledge translation to learners and supervisors not present and aligns curricular goals and objectives to actual cases. Reviewing these cases in a group setting provides professional development of airway skills in a safe and supportive environment for both learners and supervisors.
Educational Objectives: •Review intubations to highlight curricular goals...

Choose Your Own Adventure (CYOA): A Medical Education Innovation for Virtual Interactive Teaching

Wed, 24 Aug 2022 00:00:00 +0000

Learning Objectives: Design an innovation feasibility project modeled after the Choose Your Own Adventure book series that involved an interactive curriculum to teach pediatric emergency medicine (PEM) topics in a virtual setting using gamification for group learning.
Introduction/Background: Gamification is gaining popularity in medical education and the pandemic necessitates novel virtual didactic methods. Virtual group learning with serious games fosters a sense of accomplishment, reinforces core knowledge, and builds teamwork via healthy competition.
Curricular Design: A novel, virtual interactive teaching tool, modeled after the popular Choose Your Own Adventure (CYOA) book series, was developed by PEM physicians. PEM topics with recent evidence-based updates were chosen: neonatal resuscitation, hematologic/oncologic emergencies, and pediatric trauma. For each topic, an hour-long CYOA module was designed on Google Forms. Various Pediatrics, Family Practice,...