Emergency Medicine Commons^™

Comparison Of In-Person Versus Virtual Ultrasound Instruction For Pediatric Residents, Jason T. Gillon, E. Liang Liu, Valerie Dutreuil, Stephanie G. Cohen, Lekha A. Shah

School of Medicine Faculty Publications

Purpose: Point-of-care ultrasound (POCUS) instruction is prevalent in medical schools but not in pediatric residency programs, even though the majority of pediatric residents desire POCUS instruction. Virtual ultrasound instruction with affordable handheld ultrasound devices may help remedy this deficiency by allowing qualified instructors to circumvent geographic and financial limitations to reach this population. This study sought to determine if virtual ultrasound instruction is an effective alternative to traditional in-person instruction in a cohort of pediatric residents for the extended Focused Assessment with Sonography in Trauma (eFAST) exam. Methods: Pediatric residents were randomized to receive either in-person or virtual instruction to …

Developing And Piloting An Online Course On Osteoporosis Using A Multidisciplinary Multi-Institute Approach- A Cross-Sectional Qualitative Study, Lena Jafri, Hafsa Majid, Arsala Jameel Farooqui, Sibtain Ahmed, Muhammad Umer Naeem Effendi, Maseeh Uz Zaman, Qamar` Riaz, Noreen Nasir, Syeda Sadia Fatima, Sarah Nadeem, Rizwan Haroon Rashid, Aysha Habib

Department of Pathology and Laboratory Medicine

Introduction: Postgraduate medical trainees (PGs) in developing nations face various educational hurdles due to limited access to quality resources and training facilities. This study aimed to assess the effectiveness of e-learning, particularly Massive Open Online Courses (MOOCs), within postgraduate medical education. It involved the development of a customized online course focused on osteoporosis for PGs and an examination of their perspectives and preferences concerning online learning methods like Virtual Learning Environment (VLE) platforms.
Methods: The study was conducted from January 2018 to December 2020. A multi-institutional, multidisciplinary team was assembled to design an osteoporosis course on the VLE platform. PGs …

Survey Of Pediatric Critical Care Fellows On Postresuscitation Debriefing, Nicole K. Sather, Lauren E. Zinns, Gillian Brennan, Lily Guo, Nadia Khan, Vinod Havalad

Journal of Patient-Centered Research and Reviews

Purpose: Current guidelines recommend debriefing following medical resuscitations to improve patient outcomes. The goal of this study was to describe national trends in postresuscitation debriefing practices among pediatric critical care medicine (PCCM) fellows to identify potential gaps in fellow education.

Methods: A 13-item survey was distributed to fellows in all 76 ACGME-accredited PCCM programs in the United States in the spring of 2021. The online survey addressed frequency and timing of debriefings following medical resuscitations, whether formal training is provided, which medical professionals are present, and providers’ comfort level leading a debriefing. Results were analyzed using descriptive statistics.

Results: A …

Assessment During Covid-19: Quality Assurance Of An Online Open Book Formative Examination For Undergraduate Medical Students, Javeria Rehman, Rahila Ali Mazhar, Azam Afzal, Sara Shakil, Amber Shahmim Sultan, Romana Idress, Syeda Sadia Fatima

Department of Pathology and Laboratory Medicine

Background: The spread of COVID-19 pandemic in early 2020 compelled all the educational activities, including medical education to be shifted from face-to-face interaction to a virtual platform. This shift provided opportunities for exploring online assessment modalities. One such assessment method is an online open book exam which is a unique concept in medical education of Pakistan. Limited information is available in literature regarding open book exam for the basic science subjects. Hence, the objective of the study was to determine the quality of the open book exam administered as a pilot project to the first-year medical students.
Methods: It was …

The Impact Of The Covid-19 Pandemic On The Career Choice Of Medicine: A Cross-Sectional Study Amongst Pre-Medical Students In Pakistan, Raisa Saleh, Russell Seth Martins, Muhammad Saad, Asad Saulat Fatimi, Manzar Abbas, Inaara Akbar, Hamzah Jehanzeb, Shamila Ladak, Shamama Kaleem, Sarah Nadeem

Medical College Documents

Background: The COVID-19 pandemic has significantly affected the lives of healthcare workers due to the frontline nature of their work. Their hard work and sacrifice have forged new perceptions of healthcare workers. These changes may potentially influence students' interest in medicine. This study explores how the COVID-19 pandemic has affected premedical students' decisions to pursue medicine as a career.
Methods: A cross-sectional study using a self-designed online questionnaire was carried out amongst pre-medical students across Pakistan.
Results: A total of 1695 students from 93 public and private schools filled in the survey. After the onset of the COVID-19 pandemic, significantly …

The Current State Of Diagnostic Error Education In U.S. Medical Schools, Dakota Hall, Sandra Lablance, Brett Todd

Posters

Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians, specifically, the extent to which it is taught. We aimed to investigate the current state of diagnostic error education in U.S. medical schools.

Journal Club In The Pre-Clinical Years During Medical School, Kristin Cuadra, Steven Joseph

Posters

INTRODUCTION
Traditionally, journal clubs have been conducted within graduate medical programs to help integrate evidence-based learning. This study will be focused on beginning to integrate journal club into the pre-clinical years while implementing successful techniques used in past journal clubs. Our hypothesis is that, with a structured review instrument in place to help students analyze clinical articles, students will be able to benefit from monthly journal clubs and fully grasp concepts taught in these pre-clinical years. Overall, the results will contribute significantly in determining the efficacy of journal club and whether or not it can be a valuable tool in …

The Current State Of Diagnostic Error Education In Us Medical Schools, Dakota Hall, Brett R. Todd, Sandra Lablance

Conference Presentation Abstracts

Background: Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite this recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians on diagnostic error, specifically if diagnostic error is taught, when in the curriculum it is taught, and the format for teaching. We aimed to investigate the current state of education on diagnostic error in US medical schools. Methods: We conducted an anonymous survey of deans of medical education at US MD and DO medical schools utilizing Qualtrics. The study was distributed …

The Status And Future Of Emergency Care In The Republic Of Kenya, J. Austin Lee, Grace Wanjiku, Naomi Nduku, Adam R. Aluisio, Ramu Kharel, John Tabu Simiyu, Benjamin Wachira

Emergency Medicine, East Africa

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the …

Residency Training On The Frontlines Of The Covid-19 Pandemic - A Qualitative Study From Tanzania, Mariam Noorani, Hussein Manji, Elizabeth Mmari, Samina Somji, Nahida Z. Walli, Sherin Kassamali, Shabbir Adamjee, Nancy Matillya, Hanifa Mbithe, Aliasger Nagri, Neelam Ismail

Paediatrics and Child Health, East Africa

Introduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.

Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.

Results: …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Analysis Of An Obstetrics Point-Of-Care Ultrasound Training Program For Healthcare Practitioners In Zanzibar, Tanzania., Elizabeth A Hall, Danielle Matilsky, Rachel Zang, Naomasa Hase, Ali Habibu Ali, Patricia C Henwood, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at …

Global Point-Of-Care Ultrasound Education And Training In The Age Of Covid-19., Onyinyechi F Eke, Patricia C. Henwood, Grace W Wanjiku, Abiola Fasina, Sigmund J Kharasch, Hamid Shokoohi

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities.

Simulation-Based Mastery Learning Compared To Standard Education For Discussing Diagnostic Uncertainty With Patients In The Emergency Department: A Randomized Controlled Trial., Danielle M. Mccarthy, Rhea E. Powell, Kenzie A. Cameron, David H. Salzman, Dimitrios Papanagnou, Amanda Doty, Benjamin E. Leiby, Katherine Piserchia, Matthew R. Klein, Xiao C. Zhang, William C. Mcgaghie, Kristin L. Rising

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications.

METHODS: The trial is a multicenter, two-arm randomized controlled trial designed to …

A Comparison Of Homemade Phantoms For Ultrasound Guided Peripheral Intravenous Catheter Insertion, Saami Zakaria, Liam Hughes, Lauren Selame, Kelly Kehm, Resa E. Lewiss, Arthur Au, Zachary Risler

Phase 1

Purpose: U/S guided peripheral intravenous catheter (PIV) placement is implemented in many clinical settings. Commercially available U/S phantoms are expensive and difficult to alter from stock. Non-commercial phantoms have been described in published literature without data showing which type is more efficacious. The primary objective of this study was to determine efficacy of various non-commercial phantoms for U/S guided PIV placement, while secondary objectives were to characterize the cost and ease of production.

Methods: This prospective observational study trialed six unique phantom models: 1) Amini ballistics gel model, 2) Morrow ballistics gel model, 3) University of California San Diego (UCSD) …

“Trauma To The Eye” – A Low Fidelity Module For Identifying Retrobulbar Hematoma And Practicing Lateral Canthotomy & Cantholysis, Jared Raikin, Dimitrios Papanagnou, Md, Ronald Hall, Md

Phase 1

Purpose: A retrobulbar hematoma (RH) can cause preventable blindness due to damage of the optic nerve. Due to its relative infrequency in the emergency department, Emergency Medecine (EM) residents have limited experience in recognizing and treating a RH. This paper outlines a simulated scenario that was developed to improve EM residents knowledge in diagnosing a RH and performing an emergent lateral canthotomy and cantholysis (LCC).

Methods: This module used a low fidelity task trainer and case vignette created for EM residents to practice recognizing a RH and perfroming a LCC. Participants took an assessment questionnaire before and after the teaching …

A Module-Based Novel Approach To Electrocardiogram Interpretation For Emergency Medicine Residents, Alexandra Koutsoubis, Emily Fishbein, Jennifer White, Md

Phase 1

Purpose: In the Emergency Department, accurate ECG interpretation is essential as many conduction abnormalities are treatable and can lead to death if inaccurately diagnosed. Learning how to read a 12-lead ECG is part of medical education, taught through the following approach: rate, rhythm, axis. In the ED, this tedious approach doesn’t relay important information that should be garnered from the ECG with accuracy. Currently, resources for residents to improve ECG interpretation skills are limited. The purpose of the study was to design a module that teaches an accurate way of interpreting an ECG, that allows for pragmatic, pattern recognition of …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Sepsis Education And Training In Medical School, Shayan Ghiaee, Dimitrios Papanagnou, Md, David F. Gaieski, Md

Phase 1

Purpose: According to the National Institutes of Health, severe sepsis strikes more than one million Americans every year. Despite the extensive research that has gone into creating the different risk stratification tools for sepsis, there is still a fifteen to thirty percent mortality rate among patients diagnosed with sepsis. We believe this is due to a lack of robust education and training of medical students in sepsis identification, and thus, the purpose of this study was to determine the extent of training and education of medical students in the identification and treatment of sepsis.

Methods: This study is aimed at …

A Module Based Method Of Teaching A Novel Approach To Electrocardiogram Interpretation, Emily Fishbein, Alexandra Koutsoubis, Jennifer White, Md, Dimitrios Papanagnou, Md

Phase 1

Purpose: The traditional approach to 12-lead electrocardiogram interpretation has limitations in the ED setting because it is tedious and does not emphasize pattern recognition for potentially fatal conditions that ED physicians must recognize. Additionally, while lecture-based learning is necessary, learning modules can help learners gain a better understanding of the material. The purpose of this study was to create and implement a self-paced learning module that teaches a novel way of ECG interpretation through the following steps: is it sinus? is it wide? is there ischemia? and does this herald sudden death?

Methods: The objective endpoint of this study was …

A Curious Critic's Guide On Writing A Five-Star Student Evaluation: Five Lessons Learned From Food Blogging., Xiao Chi Zhang, Meryl Abrams, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Timely feedback is critical in promoting learner self-reflection. When provided effectively, feedback can assist learners with the acquisition of new skills and knowledge in the ever-changing and complex landscape of healthcare. While the literature is replete on methods to provide feedback, faculty and supervisors receive little, if any, training on writing constructive feedback. Abbreviated comments (i.e., 'good job' or 'read more') provide little information on specific behaviors learners can change. As an avid food enthusiast and restaurant reviewer, I, too, am met with the challenge of writing a meaningful, constructive review (or evaluation) of a dining experience. To better assist …

Assessing The Use Of Social Media In Physician Assistant Education., Gregory K. Wanner, Andrew W. Phillips, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

Objectives: This study aims to assess physician assistant (PA) students' experiences with social media (SM) as a part of their medical education.

Methods: The study is split into two phases: Phase 1- A cross-sectional survey emailed to all PA students at four PA school campuses to assess students' prior SM experiences (226 responses, 71.1% response rate); and Phase 2- Inclusion of SM educational resources, via Twitter, within lectures performed at two PA schools. A phase-2 survey assessed students' opinions of educational SM (50 responses, 59.5% response rate) and SM usage was tracked.

Results: The phase-1 survey respondents indicated that 97.3% …

Challenging Hazards Amidst Observational Simulation In The Emergency Department: Advancing Gamification In Simulation Education Through A Novel Resident-Led Skills Competition., Nicholas Salerno, Dimitrios Papanagnou, Md, Priyha Mahesh, Kaitlin M Bowers, Scott H Pasichow, Sara Paradise, Xiao Chi Zhang

Department of Emergency Medicine Faculty Papers

Medical simulation competitions have become an increasingly popular method to provide a hands-on "gamified" approach to education and training in the health professions. The most well-known competition, SimWars, consists of well-coordinated teams that are tasked with completing a series of mind-bending clinical scenarios in front of a live audience through 'bracket-style' elimination rounds. Similarly, challenging hazards amidst observational simulation (CHAOS) in the emergency department (ED) is another novel approach to gamification in both its structure and feel. Conducted at the Council of Emergency Medicine Resident Directors (CORD) 2018 National Assembly in San Antonio, Texas, instead of assigning premeditated teams, it …

Gamification Of Hospital Utilization: Incorporating Cost-Consciousness In Daily Practices., Peter J Tomaselli, Dimitrios Papanagnou, Md, Jonathan E Karademos, Elizabeth Teixeira, Xiao Chi Zhang

Department of Emergency Medicine Faculty Papers

Healthcare costs in the United States have skyrocketed over the past decade, contributing to an estimated $750 billion in wasteful spending annually. Despite the demand to improve residency education on value-based, cost-conscious healthcare, there is no consensus on how to best teach this practice. Traditional lectures have failed to demonstrate enduring change in clinical practice patterns, provider attitudes, and reductions in hospital expenditures. We sought to evaluate whether gamification is an effective pedagogical tool to teach cost-consciousness to emergency medicine (EM) residents by creating a 60-minute interactive session based on the popular gameshow, the Price is Right. Costs and associated …

A Curious Researcher's Guide On Successfully Publishing Scientific Manuscripts., Xiao Chi Zhang, Alexander H Tran, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Publishing a manuscript in an academic journal represents more than just 'promotional currency.' It provides the opportunity to provoke debate, share your experiences, and challenge the status quo on provider practices. Writing a manuscript relies on collaboration and shared responsibility from a research team, which can often challenge mentors as they supervise and guide its development. While there are numerous online resources and peer-reviewed journal articles on 'How to write a scientific article,' we aim to tackle an even larger and overarching theme that transcends specific journal categories, writing styles, and citation formatting. In order to guide new researchers in …

Trapped As A Group, Escape As A Team: Applying Gamification To Incorporate Team-Building Skills Through An 'Escape Room' Experience, Xiao Chi Zhang, Hyunjoo Lee, Carlos Rodriguez, Joshua Rudner, Teresa M Chan, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational 'Escape Rooms' have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively 'escape the room' in the time allotted. In this regard, escape rooms share many parallels with the multitasking …

Not Your Typical Simulation Workshop: Using Legos To Train Medical Students On The Practice Of Effective Communication., Dimitrios Papanagnou, Hyunjoo Lee, Carlos Rodriguez, Xiao Chi C Zhang, Joshua Rudner

Department of Emergency Medicine Faculty Papers

As students in the health professions transition from the classroom into the clinical environment, they will be expected to effectively communicate with their team members and their patients. Effective communication skills are essential to their ability to effectively contribute to their clinical team and the patient care they deliver. The authors propose an interactive workshop that can support students' deliberate practice of communication skills. The authors designed a simulation workshop that affords students the opportunity to practice their communication and peer-to-peer coaching skills. Using LEGOs, a one-hour workshop was conducted with medical students. Students were divided into groups of two. …

Teaching The Emergency Department Patient Experience: Needs Assessment From The Cord-Em Task Force., Kory S. London, Jeffrey Druck, Matthew Silver, Douglas Finefrock

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies.

METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency …

Academic Medicine Responds To The Opioid Crisis, John Prescott

Marshall Journal of Medicine

Opioid dependence has devastated communities across the nation particularly in rural states and academic medicine has responded in a variety of ways. Through its tripartite mission of education, research, and clinical care, creative solutions are being implanted. Medical schools and teaching hospitals are partnering with public health and law enforcement agencies, as well as local healthcare providers to address the clinical, social, and rehabilitative challenges. Academic medicine continues to adapt to the needs of the nation and teach, train, and prepare the next generation of physicians to be at their best when things are at their worst.