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Tan H, Pham CL, Regen RN, Rutherford NR, Armstrong LR, Smith LM, Heidel RE. Surgical Resident Education and Performance in Extended Focused Abdominal Sonography for Trauma. Am Surg 2024; 90:1934-1936. [PMID: 38523121 DOI: 10.1177/00031348241241747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Extended focused assessment with sonography for trauma (eFAST) is a rapid triage tool aiding the detection of life-threatening injuries. In academic settings, residents perform most eFAST; however, the ACGME has no recommendations for eFAST training standards. We surveyed general surgery programs (GSPs) regarding eFAST training and established a baseline for sensitivity, specificity, and positive and negative predictive values for resident-performed eFAST. US GSP eFAST surveys were conducted by email and phone. We prospectively collected patient variables and evaluated resident performance from May to September 2022 and 2023 at an academic level I trauma center. A total of 60/339 general surgery residency programs (GSRPs) responded: Ten use Advanced Trauma Life Support (ATLS) only, n = 7 group training, n = 8 on-the-job only, and n = 33 several methods. Resident-performed eFAST had accuracy = 85.6%, sensitivity = 35.6%, specificity = 97.2%, PPV = 75%, and NPV = 87%. General surgery residency program training in eFAST is non-standardized. Sensitivity was considerably lower than the literature suggests. Positive resident-performed eFAST is generally accurate. We recommend a standardized approach to resident training in eFAST.
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Affiliation(s)
- Hannah Tan
- Quillen College of Medicine, East Tennessee State University, Johnson, TN, USA
| | - Cassidy L Pham
- Quillen College of Medicine, East Tennessee State University, Johnson, TN, USA
| | - Ramsey N Regen
- Quillen College of Medicine, East Tennessee State University, Johnson, TN, USA
| | - Noah R Rutherford
- Quillen College of Medicine, East Tennessee State University, Johnson, TN, USA
| | - Landon R Armstrong
- Quillen College of Medicine, East Tennessee State University, Johnson, TN, USA
| | - Lou M Smith
- Division of Surgical Critical Care, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Robert E Heidel
- Division of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Hillebrand G, Gartmeier M, Weiss N, Engelmann L, Stenzl A, Johnson F, Hofauer B. [Virtual DEGUM-certified course in the head and neck region-a useful complement to conventional course formats?]. HNO 2024; 72:154-160. [PMID: 38353674 PMCID: PMC10879222 DOI: 10.1007/s00106-023-01413-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine). OBJECTIVE The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses. MATERIALS AND METHODS In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination. RESULTS The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism. CONCLUSION A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital.
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Affiliation(s)
- Gabriel Hillebrand
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Martin Gartmeier
- TUM Medical Education Center, Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung, Fakultät für Medizin, Klinikum rechts der Isar, Nigerstraße 3, 81675, München, Deutschland
| | - Nora Weiss
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Luca Engelmann
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Anna Stenzl
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Felix Johnson
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benedikt Hofauer
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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Harel-Sterling M. Can you teach a hands-on skill online? A scoping review of e-learning for point-of-care ultrasound in medical education. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:66-77. [PMID: 38226294 PMCID: PMC10787851 DOI: 10.36834/cmej.75272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background There is an increasing need and interest in teaching point-of-care ultrasound (POCUS) online. The objective of this study was to systematically review the literature regarding e-learning as a method for teaching POCUS in medical education, to assess the benefits and limitations of various styles of e-learning for POCUS, and to identify gaps in the literature that could help guide future research in this field. Methods A literature search was conducted on three databases including MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Clinical Trials on October 12, 2021, retrieving a total of 1630 studies. 31 studies met the inclusion and exclusion criteria. These studies were separated into different styles of e-learning and learner outcomes were analyzed based on Kirkpatrick's hierarchy. Results The studies were categorized into three styles of e-learning: a) blended learning b) online-only (asynchronous or synchronous) and c) use of handheld machines or telesonography. POCUS knowledge and image interpretation were successfully taught online, however online-only learning for image acquisition was not as consistently effective. Blended learning and telesonography were beneficial for learning image acquisition skills. Generally, novice learners benefited most from e-learning. Conclusion E-learning for POCUS is gaining in popularity in recent years. POCUS is a complex technical skill, and depending on the individual task being taught, different styles of e-learning may be more successful. These findings can inform future POCUS educational programs.
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Affiliation(s)
- Maya Harel-Sterling
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Ontario, Canada
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Technology-enhanced trauma training in low-resource settings: A scoping review and feasibility analysis of educational technologies. J Pediatr Surg 2023; 58:955-963. [PMID: 36828675 DOI: 10.1016/j.jpedsurg.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lack of training contributes to the burden of trauma-related mortality and morbidity in low- and lower-middle-income countries (LMICs). Educational technologies present a unique opportunity to enhance the quality of trauma training. Therefore, this study reviews current technologies used in trauma courses and evaluates their feasibility for LMICs. METHODS We conducted a scoping review evaluating the learning outcomes of technology-enhanced training in general trauma assessment, team skills or any procedures covered in the 2020 Advanced Trauma Life Support® program. Based on the Technology-Enhanced Learning criteria, we created and applied a feasibility analysis tool to evaluate the technologies for use in LMICs. RESULTS We screened 6471 articles and included 64. Thirty-four (45%) articles explored training in general trauma assessment, 28 (37%) in team skills, and 24 (32%) in procedures. The most common technologies were high-fidelity mannequins (60%), video-assisted debriefing (19%), and low-fidelity mannequins (13%). Despite their effectiveness, high-fidelity mannequins ranked poorly in production, maintenance, cost, and reusability categories, therefore being poorly suited for LMICs. Virtual simulation and digital courses had the best feasibility scores, but still represented a minority of articles in our review. CONCLUSION To our knowledge, this is the first study to perform a feasibility analysis of trauma training technologies in the LMIC context. We identified that the majority of trauma courses in the literature use technologies which are less suitable for LMICs. Given the urgent need for pediatric trauma training, educators must use technologies that optimize learning outcomes and remain feasible for low-resource settings. LEVEL OF EVIDENCE IV.
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Duarte ML, dos Santos LR, Iared W, Peccin MS. Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review. SAO PAULO MED J 2022; 140:806-817. [PMID: 36043680 PMCID: PMC9671565 DOI: 10.1590/1516-3180.2021.1047.r.19052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.
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Affiliation(s)
- Márcio Luís Duarte
- MD, MSc, PhD. Musculoskeletal Radiologist, WEBIMAGEM Telerradiologia, São Paulo (SP), Brazil; and Professor, Ultrasonography, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil
| | - Lucas Ribeiro dos Santos
- MD, MSc. Endocrinologist and Professor, Physiology and Internal Medicine, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil; and Doctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Wagner Iared
- MD, PhD. Supervisor Professor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Maria Stella Peccin
- PT, PhD. Associate Professor, Department of Human Movement Sciences and Advisor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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Savage AJ, McNamara PW, Moncrieff TW, O'Reilly GM. Review article: E-learning in emergency medicine: A systematic review. Emerg Med Australas 2022; 34:322-332. [PMID: 35224870 PMCID: PMC9306619 DOI: 10.1111/1742-6723.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
E‐learning (EL) has been developing as a medical education resource since the arrival of the internet. The COVID‐19 pandemic has minimised clinical exposure for medical trainees and forced educators to use EL to replace traditional learning (TL) resources. The aim of this review was to determine the impact of EL versus TL on emergency medicine (EM) learning outcomes of medical trainees. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement using articles sourced from CINAHL, Embase, OVID Medline and PubMed. Articles were independently reviewed by two reviewers following strict inclusion and exclusion criteria. Bias was assessed using the Cochrane Risk of Bias tool. The search yielded a total of 1586 non‐duplicate studies. A total of 19 studies were included for data extraction. Fifteen of the included studies assessed knowledge gain of participants using multiple‐choice questions as an outcome measure. Eleven of the 15 demonstrated no statistically significant difference while two studies favoured EL with statistical significance and two favoured TL with statistical significance. Six of the included studies assessed practical skill gain of participants. Five of the six demonstrated no statistical significance while one study favoured EL with statistical significance. This systematic review suggests that EL may be comparable to TL for the teaching of EM. The authors encourage the integration of EL as an adjunct to face‐to‐face teaching where possible in EM curricula; however, the overall low quality of evidence precludes definitive conclusions from being drawn.
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Affiliation(s)
- Alexander J Savage
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick W McNamara
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Thomas W Moncrieff
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gerard M O'Reilly
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia
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PoSaw LL, Wubben BM, Bertucci N, Bell GA, Healy H, Lee S. Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods. J Am Coll Emerg Physicians Open 2021; 2:e12439. [PMID: 34142104 PMCID: PMC8202829 DOI: 10.1002/emp2.12439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Over the past 2 decades, emergency ultrasound has become essential to patient care, and is a mandated competency for emergency medicine residency graduation. However, the best evidence regarding emergency ultrasound education in residency training is not known. We performed a scoping review to determine the (1) characteristics and (2) outcomes of published structured training methods, (3) the quality of publications, and (4) the implications for research and training. METHODS We searched broadly on multiple electronic databases and screened studies from the United States and Canada describing structured emergency ultrasound training methods for emergency medicine residents. We evaluated methodological quality with the Medical Education Research Study Quality Instrument (MERSQI), and qualitatively summarized study and intervention characteristics. RESULTS A total of 109 studies were selected from 6712 identified publications. Publications mainly reported 1 group pretest-posttest interventions (38%) conducted at a single institution (83%), training in image acquisition (82%) and interpretation (94%) domains with assessment of knowledge (44%) and skill (77%) outcomes, and training in cardiac (18%) or vascular access (15%) applications. Innovative strategies, such as gamification, cadaver models, and hand motion assessment are described. The MERSQI scores of 48 articles ranged from 0 to 15.5 (median, 11.5; interquartile range, 9.6-13.0) out of 18. Low scores reflected the absence of reported valid assessment tools (73%) and higher level outcomes (90%). CONCLUSIONS Although innovative strategies are illustrated, the overall quality of research could be improved. The use of standardized planning and assessment tools, intentionally mapped to targeted domains and outcomes, might provide valuable formative and summative information to optimize emergency ultrasound research and training.
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Affiliation(s)
- Leila L. PoSaw
- Division of Emergency MedicineJackson Memorial HospitalMiamiFloridaUSA
| | | | | | - Gregory A. Bell
- Department of Emergency MedicineUniversity of IowaIowa CityIowaUSA
| | - Heather Healy
- Hardin Library for the Health SciencesUniversity of Iowa LibrariesIowa CityIowaUSA
| | - Sangil Lee
- Department of Emergency MedicineUniversity of IowaIowa CityIowaUSA
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8
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Eimer C, Duschek M, Jung AE, Zick G, Caliebe A, Lindner M, Weiler N, Elke G. Video-based, student tutor- versus faculty staff-led ultrasound course for medical students - a prospective randomized study. BMC MEDICAL EDUCATION 2020; 20:512. [PMID: 33327947 PMCID: PMC7741871 DOI: 10.1186/s12909-020-02431-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/07/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ultrasound education is propagated already during medical school due to its diagnostic importance. Courses are usually supervised by experienced faculty staff (FS) with patient bedside examinations or students among each other but often overbooked due to limited FS availability. To overcome this barrier, use of teaching videos may be advantageous. Likewise, peer teaching concepts solely with trained student tutors have shown to be feasible and effective. The aim was to evaluate 1) objective learning outcomes of a combined video-based, student-tutor (ViST) as compared to a FS-led course without media support, 2) acceptance and subjective learning success of the videos. METHODS Two ultrasound teaching videos for basic and advanced abdominal ultrasound (AU) and transthoracic echocardiography (TTE) were produced and six students trained as tutors. Fourth-year medical students (N = 96) were randomized to either the ViST- or FS course (6 students per tutor). Learning objectives were defined equally for both courses. Acquired practical basic and advanced ultrasound skills were tested in an objective structured clinical examination (OSCE) using modified validated scoring sheets with a maximum total score of 40 points. Acceptance and subjective learning success of both videos were evaluated by questionnaires based on Kirkpatrick's evaluation model with scale-rated closed and open questions. RESULTS 79 of 96 medical students completed the OSCE and 77 could be finally analyzed. There was no significant difference in the mean total point score of 31.3 in the ViST (N = 42) and 32.7 in the FS course (N = 35, P = 0.31) or in any of the examined basic or advanced ultrasound skill subtasks. Of the 42 ViST participants, 29 completed the AU and 27 the TTE video questionnaire. Acceptance and subjective learning success of both videos was rated positively in 14-52% and 48-88% of the rated responses to each category, respectively. Attendance of either the student or faculty tutor was deemed necessary in addition to the videos. CONCLUSIONS A ViST versus FS teaching concept was able to effectively teach undergraduate students in AU and TTE, albeit acceptance of the teaching videos alone was limited. However, the ViST concept has the potential to increase course availability and FS resource allocation.
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Affiliation(s)
- Christine Eimer
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Max Duschek
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Andreas Emanuel Jung
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Günther Zick
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, University Medical Center Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Matthias Lindner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Norbert Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany.
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Farahani S, Farahani I, Burckhardt BB, Schwender H, Laeer S. Self-Instruction Video Versus Face-to-Face Instruction of Pharmacy Students' Skills in Blood Pressure Measurement. PHARMACY 2020; 8:pharmacy8040217. [PMID: 33207585 PMCID: PMC7711835 DOI: 10.3390/pharmacy8040217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
A modern approach to clinical skill education is the use of educational videos, yet there is a shortage of literature investigating the effect of self-instruction videos (SIVs) in pharmacy students. Therefore, our objective was to investigate whether an SIV is non-inferior compared to face-to-face instruction (FTFI) in acquiring blood pressure measurement skills. The participants in this randomized controlled study were pharmacy students. The control group was taught by FTFI, while the intervention group watched an SIV. Before and after the instruction, the participants' performance was assessed by an objective structured clinical examination (OSCE). The participants completed a self-assessment survey before each OSCE session. Moreover, the participants' perception and satisfaction were assessed using another survey. The OSCE score and self-assessment score increased significantly from pre- to post-instruction in both groups. The SIV was non-inferior compared to FTFI in terms of the OSCE score, considering a predefined non-inferiority margin of -10%. The participants' self-assessment yielded inconclusive results for non-inferiority. Both instructional approaches were well received. Considering our findings, SIVs might be a valuable option for teaching pharmacy students' blood pressure measurement skills. However, depending on the skill intended to be taught, a combination of an instructional video with instructor-led teaching may be necessary.
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Affiliation(s)
- Samieh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
- Correspondence:
| | - Imaneh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Bjoern B. Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany;
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
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Monti JD, Perreault MD. Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics. Mil Med 2020; 185:e601-e608. [PMID: 32060506 DOI: 10.1093/milmed/usaa014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Advances in the portability of ultrasound have allowed it to be increasingly employed at the point of care in austere settings. Battlefield constraints often limit the availability of medical officers throughout the operational environment, leading to increased interest in whether highly portable ultrasound devices can be employed by military medics to enhance their provision of combat casualty care. Data evaluating optimal training for effective medic employment of ultrasound is limited however. This prospective observational cohort study's primary objective was to assess the impact of a 4-hour introductory training intervention on ultrasound-naïve military medic participants' knowledge/performance of the eFAST application. MATERIALS AND METHODS Conventional U.S. Army Medics, all naïve to ultrasound, were recruited from across JBLM. Volunteer participants underwent baseline eFAST knowledge assessment via a 50-question multiple-choice exam. Participants were then randomized to receive either conventional, expert-led classroom didactic training or didactic training via an online, asynchronously available platform. All participants then underwent expert-led, small group hands-on training and practice. Participants' eFAST performance was then assessed with both live and phantom models, followed by a post-course knowledge exam. Concurrently, emergency medicine (EM) resident physician volunteers, serving as standard criterion for trained personnel, underwent the same OSCE assessments, followed by a written exam to assess their baseline eFAST knowledge. Primary outcome measures included (1) post-course knowledge improvement, (2) eFAST exam technical adequacy, and (3) eFAST exam OSCE score. Secondary outcome measures were time to exam completion and diagnostic accuracy rate for hemoperitoneum and hemopericardium. These outcome measures were then compared across medic cohorts and to those of the EM resident physician cohort. RESULTS A total of 34 medics completed the study. After 4 hours of ultrasound training, overall eFAST knowledge among the 34 medics improved from a baseline mean of 27% on the pretest to 83% post-test. For eFAST exam performance, the medics scored an average of 20.8 out of a maximum of 22 points on the OSCE. There were no statistically significant differences between the medics who received asynchronous learning versus traditional classroom-based learning, and the medics demonstrated comparable performance to previously trained EM resident physicians. CONCLUSIONS A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Online, asynchronously available platforms may effectively mitigate some of the resource requirement burden associated with point-of-care ultrasound training. Future studies evaluating medic eFAST performance on real-world battlefield trauma patients are needed. Skill and knowledge retention must also be assessed for this degradable skill to determine frequency of refresher training when not regularly performed.
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Affiliation(s)
- Jonathan D Monti
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
| | - Michael D Perreault
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
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Yiu SHM, Spacek AM, Pageau PG, Woo MYC, Curtis Lee A, Frank JR. Dissecting the Contemporary Clerkship: Theory-based Educational Trial of Videos Versus Lectures in Medical Student Education. AEM EDUCATION AND TRAINING 2020; 4:10-17. [PMID: 31989065 PMCID: PMC6965666 DOI: 10.1002/aet2.10370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Despite increasing use of the flipped classroom (FC) technique in undergraduate medical education, the benefit in learning outcomes over lectures is inconsistent. Best practices in preclass video design principles are rarely used, and it is unclear if videos can replace lectures in contemporary medical education. METHODS We conducted a prospective quasi-experimental controlled educational study comparing theory-based videos to traditional lectures in a medical student curriculum. Medical students enrolled in an emergency medicine clerkship were randomly assigned to either a lecture group (LG) or a video group (VG). The slide content was identical, and the videos aligned with cognitive load theory-based multimedia design principles. Students underwent baseline (pretest), week 1 (posttest), and end-of-rotation (retention) written knowledge tests and an observed structured clinical examination (OSCE) assessment. We compared scores between both groups and surveyed student attitudes and satisfaction with respect to the two learning methods. RESULTS There were 104 students who participated in OSCE assessments (49 LG, 55 VG) and 101 students who participated in knowledge tests (48 LG, 53 VG). The difference in OSCE scores was statistically significant 1.29 (95% confidence interval = 0.23 to 2.35, t(102) = 2.43, p = 0.017), but the actual score difference was small from an educational standpoint (12.61 for LG, 11.32 for VG). All three knowledge test scores for both groups were not significantly different. CONCLUSIONS Videos based on cognitive load theory produced similar results and could replace traditional lectures for medical students. Educators contemplating a FC approach should devote their valuable classroom time to active learning methods.
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Affiliation(s)
- Stella H. M. Yiu
- Department of Emergency MedicineThe Ottawa HospitalUniversity of OttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Alena M. Spacek
- Department of Emergency MedicineThe Ottawa HospitalUniversity of OttawaOntarioCanada
| | - Paul G. Pageau
- Department of Emergency MedicineThe Ottawa HospitalUniversity of OttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Michael Y. C. Woo
- Department of Emergency MedicineThe Ottawa HospitalUniversity of OttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - A. Curtis Lee
- University of NewcastleCallaghanNew South WalesAustralia
- The Royal Australasian College of PhysiciansSydneyNew South WalesAustralia
| | - Jason R. Frank
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
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Papatsoris A, Ayoub F, Moussa M, Chakra M, Chahine N, Fares Y. The online learning in medical education: A novel challenge in the era of COVID-19 pandemic. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/huaj.huaj_9_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Wahabi HA, Esmaeil SA, Bahkali KH, Titi MA, Amer YS, Fayed AA, Jamal A, Zakaria N, Siddiqui AR, Semwal M, Car LT, Posadzki P, Car J. Medical Doctors' Offline Computer-Assisted Digital Education: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12998. [PMID: 30821689 PMCID: PMC6418481 DOI: 10.2196/12998] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/06/2019] [Accepted: 01/31/2019] [Indexed: 01/19/2023] Open
Abstract
Background The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors. Objective The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors’ knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects. Methods We searched major bibliographic databases from 1990 to August 2017 to identify relevant articles and followed the Cochrane methodology for systematic reviews of intervention. Results Overall, 27 randomized controlled trials (RCTs), 1 cluster RCT (cRCT), and 1 quasi-RCT were included in this review. The total number of participants was 1690 in addition to the cRCT, which included 24 practices. Due to the heterogeneity of the participants, interventions, and outcomes, meta-analysis was not feasible, and the results were presented as narrative summary. Compared with face-to-face learning, the effect of OCDE on knowledge gain is uncertain (ratio of the means [RM] range 0.95-1.17; 8 studies, 495 participants; very low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 0.1-0.9; 8 studies, 375 participants; very low grade of evidence). OCDE may have little or no effect on patients’ outcome compared with face-to-face education (2 studies, 62 participants; low grade of evidence). Compared with no intervention, OCDE may improve knowledge gain (RM range 1.36-0.98; 4 studies, 401 participants; low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 1.1-1.15; 4 trials, 495 participants; very low grade of evidence). One cRCT, involving 24 practices, investigated patients’ outcome in this comparison and showed no difference between the 2 groups with low-grade evidence. Compared with text-based learning, the effect of OCDE on cognitive skills gain is uncertain (RM range 0.91-1.46; 3 trials with 4 interventions; 68 participants; very low-grade evidence). No study in this comparison investigated knowledge gain or patients’ outcomes. One study assessed the CE and showed that OCDE was cost-effective when compared with face-to-face learning if the cost is less than or equal to Can $200. No trial evaluated the adverse effect of OCDE. Conclusions The effect of OCDE compared with other methods of education on medical doctors’ knowledge and cognitive skill gain is uncertain. OCDE may improve doctors’ knowledge compared with no intervention but its effect on doctors’ cognitive skills is uncertain. OCDE may have little or no effect in improving patients’ outcome.
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Affiliation(s)
- Hayfaa Abdelmageed Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia
| | - Samia Ahmed Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia
| | - Khawater Hassan Bahkali
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maher Abdelraheim Titi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Yasser Sami Amer
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amel Ahmed Fayed
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.,High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Amr Jamal
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Medical Informatics and e-Learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amna Rehana Siddiqui
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Monika Semwal
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Paul Posadzki
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Davy RB, Hamel PE, Su Y, Berry CR, Conner BJ. Evaluation of Two Training Methods for Teaching the Abdominal Focused Assessment with Sonography for Trauma Technique (A-FAST) to First- and Second-Year Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 46:258-263. [PMID: 30285594 DOI: 10.3138/jvme.0517-059r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound techniques, including focused assessment with sonography for trauma (FAST) examinations, are commonly used in veterinary practice, making inclusion of ultrasound in veterinary curricula increasingly important. The best approach for teaching ultrasound techniques in veterinary medicine has not been evaluated. This study compared the results of two training techniques, live-animal training and online video instruction, on students' performance during abdominal FAST (A-FAST) examinations. Thirty-eight first- and second-year veterinary students were randomly assigned to learn A-FAST via a live-animal laboratory or an instructional video. The live-animal group received one-on-one instruction in A-FAST techniques during a single laboratory. The video group received a link to an instructional video demonstrating A-FAST techniques, allowing unlimited viewing opportunities over a two-week period. Both groups were also provided written instructional information. All participants were assessed on their ability to find and correctly name the four A-FAST quadrants on a live animal. We found a significant difference between the two groups in the students' ability to identify the diaphragmatic-hepatic (DH) view, but for the other three views (hepatorenal, splenorenal, and cystocolic), training method did not affect performance. Results suggest the potential for using a multi-modal instructional approach to teach ultrasound techniques to veterinary students.
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Rose E, Jhun P, Baluzy M, Hauck A, Huang J, Wagner J, Kearl YL, Behar S, Claudius I. Flipping the Classroom in Medical Student Education: Does Priming Work? West J Emerg Med 2017; 19:93-100. [PMID: 29383062 PMCID: PMC5785208 DOI: 10.5811/westjem.2017.8.35162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction The emergency medicine (EM) clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by "priming" the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing). Methods Twenty-minute videos were to be viewed prior to the didactic session. Students were assigned to either the fever or SOB group and received links to those respective videos. All participating students took a pre-test prior to viewing the online lectures. For analysis, test scores were placed into concordant groups (test results on fever questions in the group assigned the fever video and test results on SOB questions in the group assigned the SOB video) and discordant groups (crossover between video assigned and topic tested). Each subject contributed one set of concordant results and one set of discordant results. Descriptive statistics were performed with the Mann-Whitney U test. Lecture links were distributed to students two weeks prior to the in-class session for seven months and three days prior to the in-class session for eight months (in which both groups included both EM-bound and non-EM bound students). Results In the fifteen-month study period, 64% of students rotating through the EM elective prepared for the in class session by watching the videos. During ten months where exclusively EM-bound students were rotating (n=144), 71.5% of students viewed the lectures. In four months where students were not EM-bound (n=54), 55.6% of students viewed the lectures (p=0.033). Participation was 60.2% when lecture links were given three days in advance and 68.7% when links were given two weeks in advance (p=0.197). In the analysis of concordant scores, the pre-test averaged 56.7% correct, the immediate post-test averaged 78.1% correct, and the delayed post-test was 67.2%. In the discordant groups, the pretest averaged 51.9%, the immediate posttest was 67.1% and the delayed by 68.8%. In the concordant groups, the immediate post-test scores improved by 21.4%, compared with 15.2% in the discordant groups (p = 0.655). In the delayed post-test the concordant scores improved by 10.5% and discordant scores by 16.9 percent (p=0.609). Sixty-two percent of students surveyed preferred the format of online videos with in-class case discussion to a traditional lecture format. Conclusion Immediate post-tests and delayed post-tests improved but priming was not demonstrated to be a statistically superior educational method in this study. Medical student completion of the preparatory materials for the EM rotation session increased when the students were EM-bound. Participation rates were not significantly different when given at two weeks versus three days.
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Affiliation(s)
- Emily Rose
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Paul Jhun
- University of California San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California
| | - Matthew Baluzy
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Aaron Hauck
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan Huang
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan Wagner
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Yvette L Kearl
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Solomon Behar
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Ilene Claudius
- Los Angeles County-University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
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16
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Richmond H, Copsey B, Hall AM, Davies D, Lamb SE. A systematic review and meta-analysis of online versus alternative methods for training licensed health care professionals to deliver clinical interventions. BMC MEDICAL EDUCATION 2017; 17:227. [PMID: 29169393 PMCID: PMC5701457 DOI: 10.1186/s12909-017-1047-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/02/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND Online training is growing in popularity and yet its effectiveness for training licensed health professionals (HCPs) in clinical interventions is not clear. We aimed to systematically review the literature on the effectiveness of online versus alternative training methods in clinical interventions for licensed Health Care Professionals (HCPs) on outcomes of knowledge acquisition, practical skills, clinical behaviour, self-efficacy and satisfaction. METHODS Seven databases were searched for randomised controlled trials (RCTs) from January 2000 to June 2015. Two independent reviewers rated trial quality and extracted trial data. Comparative effects were summarised as standardised mean differences (SMD) and 95% confidence intervals. Pooled effect sizes were calculated using a random-effects model for three contrasts of online versus (i) interactive workshops (ii) taught lectures and (iii) written/electronic manuals. RESULTS We included 14 studies with a total of 1089 participants. Most trials studied medical professionals, used a workshop or lecture comparison, were of high risk of bias and had small sample sizes (range 21-183). Using the GRADE approach, we found low quality evidence that there was no difference between online training and an interactive workshop for clinical behaviour SMD 0.12 (95% CI -0.13 to 0.37). We found very low quality evidence of no difference between online methods and both a workshop and lecture for knowledge (workshop: SMD 0.04 (95% CI -0.28 to 0.36); lecture: SMD 0.22 (95% CI: -0.08, 0.51)). Lastly, compared to a manual (n = 3/14), we found very low quality evidence that online methods were superior for knowledge SMD 0.99 (95% CI 0.02 to 1.96). There were too few studies to draw any conclusions on the effects of online training for practical skills, self-efficacy, and satisfaction across all contrasts. CONCLUSIONS It is likely that online methods may be as effective as alternative methods for training HCPs in clinical interventions for the outcomes of knowledge and clinical behaviour. However, the low quality of the evidence precludes drawing firm conclusions on the relative effectiveness of these training methods. Moreover, the confidence intervals around our effect sizes were large and could encompass important differences in effectiveness. More robust, adequately powered RCTs are needed.
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Affiliation(s)
- Helen Richmond
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bethan Copsey
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amanda M. Hall
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - David Davies
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah E. Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med 2017; 9:57-62. [PMID: 28794661 PMCID: PMC5536884 DOI: 10.2147/oaem.s120145] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.
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Affiliation(s)
| | - Sirote Wongwaisayawan
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Park EJ, Yoon YT, Hong CK, Ha YR, Ahn JH. Randomized, noninferiority study between video versus hand ultrasound with wet foam dressing materials to simulate B-lines in lung ultrasound: A CONSORT-compliant article. Medicine (Baltimore) 2017; 96:e7642. [PMID: 28746228 PMCID: PMC5627854 DOI: 10.1097/md.0000000000007642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study evaluated the efficacy of a teaching method using simulated B-lines of hand ultrasound with a wet foam dressing material. METHODS This prospective, randomized, noninferiority study was conducted on emergency medical technician students without any relevant training in ultrasound. Following a lecture including simulated (SG) or real video clips (RG) of B-lines, a posttest was conducted and a retention test was performed after 2 months. The test consisted of questions about B-lines in 40 randomly mixed video clips (20 simulated and 20 real videos) with 4 answer scores (R-1 [the correct answer score for the real video clips] vs S-1 [the correct answer score for the simulated video clips] in the posttest, R-2 [the correct answer score for the real video clips] vs S-2 [the correct answer score for the simulated video clips] in the retention test). RESULTS A total of 77 and 73 volunteers participated in the posttest (RG, 38; SG, 39) and retention test (RG, 36; SG, 37), respectively. There was no significant (P > .05) difference in scores of R-1, S-1, R-2, or S-2 between RG and SG. The mean score differences between RG and SG were -0.6 (95% confidence interval [CI]: -1.49 to 0.11) in R-1, -0.1 (95% CI: -1.04 to 0.86) in S-1, 0 (95% CI: -1.57 to 1.50) in R-2, and -0.2 (95% CI: -1.52 to 0.25) in S-2. The mean differences and 95% CIs for all parameters fell within the noninferiority margin of 2 points (10%). CONCLUSION Simulated B-lines of hand ultrasound with a wet foam dressing material were not inferior to real B-lines. They were effective for teaching and simulations. TRIAL REGISTRATION The study was registered with the Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp (KCT0002144).
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Affiliation(s)
- Eun Jung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
| | - Young Tak Yoon
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea
| | - Chong Kun Hong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea
| | - Young Rock Ha
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
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Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med 2017; 6:1-12. [PMID: 28224102 PMCID: PMC5295164 DOI: 10.5492/wjccm.v6.i1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.
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Rose E, Claudius I, Tabatabai R, Kearl L, Behar S, Jhun P. The Flipped Classroom in Emergency Medicine Using Online Videos with Interpolated Questions. J Emerg Med 2016; 51:284-291.e1. [PMID: 27381954 DOI: 10.1016/j.jemermed.2016.05.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Utilizing the flipped classroom is an opportunity for a more engaged classroom session. This educational approach is theorized to improve learner engagement and retention and allows for more complex learning during class. No studies to date have been conducted in the postgraduate medical education setting investigating the effects of interactive, interpolated questions in preclassroom online video material. OBJECTIVES We created a flipped classroom for core pediatric emergency medicine (PEM) topics using recorded online video lectures for preclassroom material and interactive simulations for the in-classroom session. METHODS Lectures were filmed and edited to include integrated questions on an online platform called Zaption. One-half of the residents viewed the lectures uninterrupted (Group A) and the remainder (Group B) viewed with integrated questions (2-6 per 5-15-min segment). Residents were expected to view the lectures prior to in-class time (total viewing time of approximately 2½ h). The 2½-h in-class session included four simulation and three procedure stations, with six PEM faculty available for higher-level management discussion throughout the stations. Total educational time of home preparation and in-class time was approximately 5 h. RESULTS Residents performed better on the posttest as compared to the pretest, and their satisfaction was high with this educational innovation. In 2014, performance on the posttest between the two groups was similar. However, in 2015, the group with integrated questions performed better on the posttest. CONCLUSION An online format combined with face-to-face interaction is an effective educational model for teaching core PEM topics.
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Affiliation(s)
- Emily Rose
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, California
| | - Ilene Claudius
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, California
| | - Ramin Tabatabai
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, California
| | - Liza Kearl
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, California
| | - Solomon Behar
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, California
| | - Paul Jhun
- Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, California
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22
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Paddock MT, Bailitz J, Horowitz R, Khishfe B, Cosby K, Sergel MJ. Disaster response team FAST skills training with a portable ultrasound simulator compared to traditional training: pilot study. West J Emerg Med 2015; 16:325-30. [PMID: 25834682 PMCID: PMC4380391 DOI: 10.5811/westjem.2015.1.23720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 01/16/2023] Open
Abstract
Introduction Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team. Methods We randomized participants into one of three training groups stratified by provider role: Group A. Traditional Skills Training, Group B. US Simulator Skills Training, and Group C. Traditional Skills Training Plus US Simulator Skills Training. After skills training, we measured participants’ FAST image acquisition and interpretation skills using a standardized direct observation tool (SDOT) with healthy models and review of FAST patient images. Pre- and post-course US and FAST knowledge were also assessed using a previously validated multiple-choice evaluation. We used the ANOVA procedure to determine the statistical significance of differences between the means of each group’s skills scores. Paired sample t-tests were used to determine the statistical significance of pre- and post-course mean knowledge scores within groups. Results We enrolled 36 participants, 12 randomized to each training group. Randomization resulted in similar distribution of participants between training groups with respect to provider role, age, sex, and prior US training. For the FAST SDOT image acquisition and interpretation mean skills scores, there was no statistically significant difference between training groups. For US and FAST mean knowledge scores, there was a statistically significant improvement between pre- and post-course scores within each group, but again there was not a statistically significant difference between training groups. Conclusion This pilot study of a deployed mixed-provider disaster response team suggests that a novel portable US simulator may provide equivalent skills training in comparison to traditional live instructor and model training. Further studies with a larger sample size and other measures of short- and long-term clinical performance are warranted.
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Affiliation(s)
- Michael T Paddock
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - John Bailitz
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Russ Horowitz
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Basem Khishfe
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Karen Cosby
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Michelle J Sergel
- John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
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23
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Mohammad A, Hefny AF, Abu-Zidan FM. Focused Assessment Sonography for Trauma (FAST) training: a systematic review. World J Surg 2014; 38:1009-18. [PMID: 24357247 DOI: 10.1007/s00268-013-2408-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to systematically review the different methods for training Focused Assessment Sonography for Trauma (FAST), course design, and requirements for hospital credentialing. METHODS We searched MEDLINE/PubMed, EMBASE, and the Cochrane database and performed a manual search of selected papers. All papers and abstracts written in English that studied training and education of FAST were included. Papers were critically evaluated, looking into training methods and models of FAST, their advantages and disadvantages, number and type of training hours, practice exams in the course, and number of cases advised to achieve hospital credentialing. RESULTS A total of 52 studies were critically analyzed. The theoretical part of the courses lasted over a median (range) of 4 (1-16) h (n = 35 studies), while the practical part lasted over a median (range) of 4 (1-32) h (n = 34 studies). The participants performed a median (range) of 10 (3-20) FAST exams during the courses (n = 13 studies). The most commonly used model was the normal human model (65 %), followed by peritoneal dialysis patients (27 %). The least used models were animal (4 %) and cadaveric models (2 %). Each of these models had their advantages and disadvantages. The median number (range) of FAST exams needed for credentialing was 50 (10-200) (n = 19 studies). CONCLUSION Standardization of FAST training is important to improving the clinical impact of FAST. Different models used in FAST training are complementary; each has its own advantages and disadvantages. It is recommended that FAST courses be at least 2 days (16 h) long. The first day should include 4 h of theory and 4 h of training on normal human models. The second day should enforce learning using animal models, case scenarios including video clips, or simulators.
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Affiliation(s)
- Alshafi Mohammad
- Trauma Group, Department of Surgery, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates
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The cognitive benefits of dynamic representations in the acquisition of spatial navigation skills. COMPUTERS IN HUMAN BEHAVIOR 2014. [DOI: 10.1016/j.chb.2013.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Evaluation of a Training Curriculum for Prehospital Trauma Ultrasound. J Emerg Med 2013; 45:856-64. [DOI: 10.1016/j.jemermed.2013.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 02/07/2013] [Accepted: 05/01/2013] [Indexed: 11/24/2022]
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Assessment of a new e-learning system on thorax, trachea, and lung ultrasound. Emerg Med Int 2013; 2013:145361. [PMID: 24324889 PMCID: PMC3845847 DOI: 10.1155/2013/145361] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Lung ultrasound has become an emerging tool in acute and critical care medicine. Combined theoretical and hands-on training has been required to teach ultrasound diagnostics. Current computer technology allows for display, explanation, and animation of information in a remote-learning environment. Objective. Development and assessment of an e-learning program for lung ultrasound. Methods. An interactive online tutorial was created. A prospective learning success study was conducted with medical students using a multiple-choice test (Trial A). This e-learning program was used as preparation for a certified course followed by an evaluation of trained doctors (Trial B) by linear analogue scales. Pretests were compared with postcourse tests and sustainability tests as well as a posttest of a one-day custom classroom training. Results. In Trial A, during the learning success study (n = 29), the increase of correct answers was 11.7 to 17/20 in the post-test and to 16.6/20 in the sustainability test (relative change 45.1%, P < 0.0001). E-learning almost equalled scores of classroom-based training regarding gain and retention of factual knowledge. In Trial B, nineteen participating doctors found a 79.5% increase of knowledge (median, 95% CI: 69%; 88%). Conclusion. The basics of lung ultrasound can be taught in a highly effective manner using e-learning.
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Knowledge and usability of a trauma training system for general surgery residents. Am J Surg 2013; 205:681-4. [DOI: 10.1016/j.amjsurg.2012.07.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/26/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022]
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Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J 2013; 31:369-73. [PMID: 23428721 DOI: 10.1136/emermed-2012-201789] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department patients. METHODS Following a web-based learning module and 3 h of proctored practical training, emergency medicine trainees were evaluated in technical and interpretative skills in estimating left ventricular function, detection of pericardial effusion and inferior vena cava (IVC) diameter measurements using bedside-focused echocardiography on emergency department patients. An inter-rater agreement analysis was performed between the trainees and a board-certified cardiologist. RESULTS 100 focused echocardiography examinations were performed by nine emergency medicine trainees. Agreement between the trainees and the cardiologist was 93% (K=0.79, 95% CI 0.773 to 0.842) for visual estimation of left ventricular function, 92.9% (K=0.80, 95% CI 0.636 to 0.882) for quantitative left ventricular ejection fraction by M-mode measurements, 98% (K=0.74, 95% CI 0.396 to 1.000) for the detection of pericardial effusion, and 64.2% (K=0.45, 95% CI 0.383 to 0.467) for IVC diameter assessment. The Bland-Altman limits of agreement for left ventricular function was -9.5% to 13.7%, and a Pearson's correlation yielded a value of 0.82 (p<0.0001, 95% CI 0.734 to 0.881). The trainees detected pericardial effusion with a sensitivity of 60%, specificity of 100%, positive predictive value of 100% and negative predictive value of 97.9%. CONCLUSIONS Emergency medicine trainees were found to be able to perform and interpret focused echocardiography reliably after a short duration of training.
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Affiliation(s)
- Aida Bustam
- Department of Trauma and Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Muhaimin Noor Azhar
- Department of Trauma and Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ramesh Singh Veriah
- Department of Cardiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kulenthran Arumugam
- Medical Education and Research Development Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Alexander Loch
- Departments of Cardiology and Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Fisher J, Lin M, Coates WC, Kuhn GJ, Farrell SE, Maggio LA, Shayne P. Critical appraisal of emergency medicine educational research: the best publications of 2011. Acad Emerg Med 2013; 20:200-8. [PMID: 23406080 DOI: 10.1111/acem.12070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/21/2012] [Accepted: 08/30/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to critically appraise and highlight medical education research studies published in 2011 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). METHODS A search of the English language literature in 2011 querying PubMed, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified EM studies that used hypothesis-testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This method was used previously to appraise medical education published in 2008, 2009, and 2010. RESULTS Forty-eight educational research papers were identified. Comparing the literature of 2011 to that of 2008 through 2010, the number of published educational research papers meeting the criteria increased over time from 30, to 36, to 41, and now to 48. Five medical education research studies met the a priori criteria for inclusion as exemplary and are reviewed and summarized in this article. The number of funded studies remained fairly stable over the past 3 years, at 13 (2008), 16 (2009), 9 (2010), and 13 (2011). As in past years, research involving the use of technology accounted for almost half (n = 22) of the publications. Observational study designs accounted for 28 of the papers, while nine studies featured an experimental design. CONCLUSIONS Forty-eight EM educational studies published in 2011 and meeting the criteria were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2011 papers are noted.
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Affiliation(s)
- Jonathan Fisher
- Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston; MA
| | - Michelle Lin
- The Department of Emergency Medicine; University of California at San Francisco; San Francisco; CA
| | - Wendy C. Coates
- The Department of Emergency Medicine; Harbor-UCLA Medical Center; University of California, Los Angeles-David Geffen School of Medicine, and Los Angeles Biomedical Research Institute at Harbor-UCLA; Los Angeles; CA
| | - Gloria J. Kuhn
- The Department of Emergency Medicine; Wayne State University; Farming Hills; MI
| | - Susan E. Farrell
- The Office of Graduate Medical Education; Partners Healthcare System; Center for Teaching and Learning; Harvard Medical School; and Department of Emergency Medicine; Brigham and Women's Hospital; Boston; MA
| | - Lauren A. Maggio
- The Lane Medical Library; Stanford University School of Medicine; Stanford; CA
| | - Philip Shayne
- and The Department of Emergency Medicine; Emory University School of Medicine; Atlanta; GA
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