Learning Objectives: Understand how residency programs track procedures. Understand how real-time procedure tracking can improve documentation. Understand how real-time procedure tracking can make SIM labs more efficient.

Objective: Tracking of residency procedures is vital to the continued accreditation of Emergency Medicine (EM) residency programs. We sought to determine if a Procedural Achievement Count Evaluation (PACE) score utilization increases ACGME procedural reporting.

Methods: A spreadsheet was created on Google Sheets, which contains the names of all the residents and the ACGME required procedures. The minimum procedural threshold is divided by the total months of residency (36) and then multiplied by each resident’s month in training. We termed the minimal monthly requirement the PACE score. Each resident’s tallied procedures are compared to the PACE value. Residents had open access to the Google Sheets PACE score, attendings were educated monthly, and residents additionally were educated at their semi-annual exams regarding their comparative score. Documented procedures were subdivided into “live” or “SIM”. The number of procedures reported by the third year classes one year before and one year after implementation were tallied. The number of procedures compared to the minimum ACGME requirement were calculated. A two-tailed Wilcoxon Signed-Rank test was utilized, with a p-value of less than 0.05 for statistically significant.

Results: Of the fifteen core procedures reported to the ACGME, 87% (N=13) had increased totals following implementation (P=0.004). The only two procedures without increases were pericardiocentesis and central lines. The average percent increase of all procedures when compared to the minimum requirement was 37% (95% CI, 23,46). The number of live procedures increased in 60% (N=9) of procedures (p=0.06). Additionally, SIM procedures increased in 86% of those procedures that utilized SIM. (N=6 procedures, p=NS). The average percentage increase of SIM procedures was 24% (95% CI, 18,36).

Conclusion: Utilization of a PACE score significantly improved ACGME procedural reporting numbers overall and specifically increased SIM utilization.

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 (44% said “much more,” 50% said “a little more.”) When asked about the areas in which they get the most feedback, 67% of respondents said they get the most feedback about charting/documentation and 20% said they get the most feedback about clinical care. When asked about the areas in which they wish they had more feedback, 94% would like more feedback on clinical care with critically-ill patients, 81% wanted more feedback on clinical care in non-critically-ill patients, and 44% wanted more feedback with procedures. 38% wanted more feedback about interactions with consultants, while only 31% wanted more feedback about interactions with patients. When asked about the obstacles to getting constructive feedback, 94% identified the patient volume / workload, while 63% identified the system being used (New Innovations.)

Conclusion: Despite the emphasis our program puts on feedback, residents still perceive that there is not enough, especially when it comes to clinical care. Surveys like this can be eye-opening and will hopefully lead to changes in faculty behavior to improve the teaching we provide.

Learning Objective: Understand how residents’ living situations and support structure might affect their wellness.

Background: EM residents are known to be high-risk for depression; in all likelihood the Covid-19 pandemic added to this risk. In addition to the understandable work stressors, social isolation caused by the lockdowns likely has affected their support structure.

Objectives: Using validated psychometric testing, we sought to determine the levels of depression, anxiety, and stress in EM residents in a region severely impacted by the pandemic. We hypothesized that residents living alone would have more depression, anxiety and stress than those living with family or other roommates.

Methods: Setting: An EM residency program in the state greatly affected by Covid-19. All EM residents were surveyed a year into the pandemic using the Depression, Anxiety, Stress Scales (DASS). This scale has been validated in the psychology literature across multiple settings. Surveys were anonymous to promote honesty. Residents were also surveyed about their living situations and then separated into two groups based on whether they lived alone or with other people. Levels of depression, anxiety, and stress were determined for each group and compared. Differences between the groups and 95% confidence intervals (CI) were calculated.

Results: 26 of 27 residents (96%) completed the survey. 12 residents lived by themselves and 16 residents lived with others. In terms of depression, the incidence was 58% for those living alone vs. 23% for those living with others (Difference -29%, CI: -69,11). In terms of anxiety, the incidence was 33% for those living alone vs 29% for those living with others (Difference -4%, CI: -43,35). In terms of stress, the incidence was 50% vs. 43% for those living with others (Difference -7%, CI:-49,35).

Conclusion: During the pandemic, the rates of depression, anxiety and stress in emergency residents as measured by the DASS are high overall, but with the small sample size no differences between those who live alone and those that live with others was shown.

Objectives: Acute complications from cocaine abuse are commonly treated in the emergency department (ED); one of the most consequential is status epilepticus. The incidence of this complication is not clearly defined in the prior literature on cocaine-associated sequelae. We evaluated the incidence of status epilepticus in patients with seizures secondary to suspected cocaine use.

Methods: We performed a retrospective multi-center study of patients with seizures resulting from cocaine use. We identified study subjects at 15 hospitals by record review and conducted a computer-assisted records search to identify patients with seizures for each institution over a four-year period. We selected subjects from this group on the basis of cocaine use and determined the occurrence of status epilepticus among them. Data were collected on each subject using a standardized data collection form.

Results: We evaluated 43 patients in the ED for cocaine-associated seizures. Their age range was 17 to 54, with a mean age was 31 years; 53% were male. Of 43 patients, 42 experienced a single tonic-clonic seizure and one developed status epilepticus. All patients had either a history of cocaine use or positive urine drug screen for cocaine.

Conclusion: Despite reported cases of status epilepticus with cocaine-induced seizures, the incidence of this complication was unclear based on prior literature. This study shows that most cocaine-associated seizures are self-limited. [West J Emerg Med. 2010; 11(2):157-160.]