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Sahin H, Babus SB, Köse A, Erdogan S. The effect of Ramadan on elderly patients presenting to the emergency department. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:76-82. [PMID: 38692594 DOI: 10.25259/nmji_261_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background Patients visiting the emergency department (ED) may show variations by certain time periods such as Ramadan. We wished to ascertain whether Ramadan affects the ED presentations, clinical conditions and outcomes of patients aged 65 years or older. Methods . Patients aged 65 years or older who presented to ED in Ramadan and in the following month in 2018 were reviewed retrospectively. Results . A total of 1947 patients were enrolled, of whom 958 presented in Ramadan and 989 in the following month. The patients who presented in Ramadan most commonly (23.8%) presented between 8 p.m. and 11.59 p.m.; patients who presented in the following month most commonly (24%) presented between 8 a.m. and 11.59 a.m. (p=0.26). Complaints concerning the central nervous system (CNS) were more common in the month after Ramadan (p<0.0001). Diagnoses related to the cardiovascular system were more commonly made in Ramadan (p=0.037), whereas those related to CNS, otorhinolaryngology and oncology were more commonly made in the following month (p=0.0005, p=0.024 and p=0.003, respectively). No significant difference was found between the two groups with respect to outcomes (p=0.36). Compared to patients who presented in Ramadan, those that presented in the following month had a significantly longer ED stay (p=0.036). Conclusion . Our study detected no significant difference between the two groups with respect to the time of presentation and ED outcomes. Patients who presented in Ramadan had a lower incidence of CNS complaints; a higher incidence of cardiovascular diagnoses; lower incidences of CNS, oncological and otorhinolaryngological diagnoses and a significantly shorter length of ED stay.
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Affiliation(s)
- Hasan Sahin
- Mersin City Education Research Hospital Emergency Service, Turkey
| | - Seyran Bozkurt Babus
- Department of Emergency Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Ataman Köse
- Department of Emergency Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Semra Erdogan
- Biostatistics and Medical Informatics, Medical Faculty, Mersin University, Mersin, Turkey
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Nti BK, Phillips W, Sarmiento E, Russell F. Effect of a point-of-care ultrasound (POCUS) curriculum on emergency department soft tissue management. Ultrasound J 2022; 14:41. [PMID: 36269462 PMCID: PMC9587168 DOI: 10.1186/s13089-022-00292-4] [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: 11/25/2021] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric emergency department (ED) visits for superficial skin and soft tissue infections (SSTI) have steadily been increasing and point-of-care ultrasound (POCUS) continues to be an effective modality to improve management and shorter ED length of stays (LOS). Objective We sought to determine the impact of a soft tissue POCUS curriculum on POCUS utilization, ED LOS, and cost-effectiveness. Methods This was a retrospective pre- and post-interventional study of pediatric patients aged 0 to 17 years. Patients presenting to ED with international classification of disease 9 or 10 code for abscess or cellulitis were included. Data were collected a year before and after curriculum implementation with a 1-year washout training period. Training included continuing medical education, greater than 25 quality assured examinations, and a post-test. We compared diagnostic imaging type, ED LOS, and mean charges in patients with SSTI. Results We analyzed data on 119 total patients, 38 pre- and 81 post-intervention. We found a significant increase in the total number of POCUS examinations performed pre- to post-curriculum intervention, 26 vs. 59 (p = 0.0017). Mean total charges were significantly decreased from $3,762 (± 270) to $2,622 (± 158; p = 0.0009). There was a significant trend towards a decrease in average ED LOS 282 (standard error of mean [SEM] ± 19) vs 185 (± 13) minutes (p = 0.0001). Conclusions Implementation of a soft tissue POCUS curriculum in a pediatric ED was associated with increased POCUS use, decreased LOS, and lower cost. These findings highlight the importance of POCUS education and implementation in the management of pediatric SSTI.
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Affiliation(s)
- Benjamin K Nti
- Division of Pediatric Emergency Medicine Division of Clinical Ultrasound Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FT 3, Indianapolis, IN 46202, US.
| | - Whitney Phillips
- Department of Pediatrics Riley, Hospital for Children at Indiana University Health, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN 46202, US
| | - Elisa Sarmiento
- Division of Pediatric Emergency Medicine Division of Clinical Ultrasound Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FT 3, Indianapolis, IN 46202, US
| | - Frances Russell
- Division of Pediatric Emergency Medicine Division of Clinical Ultrasound Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FT 3, Indianapolis, IN 46202, US
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Arichai P, Delaney M, Slamowitz A, Rosario R, Gordish-Dressman H, Basu S, Kern J, Maxwell A, Abo A. Pediatric Residency Point-of-Care Ultrasound Training Needs Assessment and Educational Intervention. Cureus 2022; 14:e28696. [PMID: 36204025 PMCID: PMC9527041 DOI: 10.7759/cureus.28696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Prior studies showed that point-of-care ultrasound (POCUS) training is not commonly offered in pediatric residency. We assessed the need for a pediatric POCUS curriculum by evaluating pediatric trainees’ attitudes toward the use of POCUS and identifying barriers to training. We also aimed to evaluate the impact of a POCUS educational intervention on self-efficacy and behavior. Methods We conducted a cross-sectional survey of pediatric residents in a single large freestanding children’s hospital distributed via an institutional listserv and administered online. The survey included opinion-rating of statements regarding POCUS and barriers to training. We also offered a two-week POCUS course with online modules and hands-on scanning. Participating residents completed pre- and post-course knowledge assessments and follow-up surveys up to 12 months following the course to assess POCUS use and self-report confidence on POCUS indications, acquisition, interpretation, and clinical application. Results Forty-nine respondents were included in the survey representing all three pediatric levels with 16 specialty interest areas. Ninety-six percent of trainees reported that POCUS is an important skill in pediatrics. Ninety-two percent of trainees reported that residency programs should teach residents how to use POCUS. The most important perceived barriers to POCUS training were scheduling availability for POCUS rotations and lack of access to an ultrasound machine. Fourteen participants completed the pre- and post-course knowledge tests, with eight and six participants also completing the six- and 12-month follow-up surveys, respectively. Self-ratings of confidence were significantly improved post-intervention in indications (P = 0.007), image acquisition (P = 0.002), interpretation (P = 0.002), and clinical application (P = 0.004). This confidence improvement was sustained up to 6-12 months (P = 0.004-0.032). Participants also reported higher categorical POCUS use after course completion (P = 0.031). Conclusions Pediatric trainees perceive POCUS as an important skill, hold favorable opinions towards the use of POCUS, and support POCUS training within a pediatric residency. A POCUS course can improve resident POCUS knowledge, instill confidence, and motivate higher POCUS use. Further study is needed to evaluate POCUS applications in pediatric medicine to develop a standardized POCUS curriculum and establish a training guideline for pediatric residency.
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Bozkurt Babuş S, Köse A, Erdoğan S, Kiraz M, İyikesici F. Risk factors and mortality in elderly patients with severe hyponatremia admitted to the emergency department. Ir J Med Sci 2022; 192:861-870. [PMID: 35420366 DOI: 10.1007/s11845-022-02989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was aimed at determining the risk factors associated with mortality in elderly patients with severe hyponatremia admitted to the emergency department. MATERIALS AND METHODS The data of patients aged ≥ 65 years who were admitted to the emergency department and whose serum sodium levels were < 125 mEq/L were retrospectively collected. RESULTS Mortality was associated with chronic liver disease/cirrhosis (p = 0.036), metastatic tumor (p = 0.007) and solid tumor (p = 0.013) cancers, antiarrhythmic drug use (p = 0.003), potassium-sparing diuretic use (p = 0.044), antineoplastic drug use (p = 0.0029), and dialysis treatment (p = 0.015). The following cutoff values were determined to be predictive of mortality: urea > 63.6 (AUC: 0.771; p = 0.0001), creatinine > 1.39 (AUC: 0.675; p = 0.0003), potassium > 4.64 (AUC: 0.711; p = 0.0001), C-reactive protein > 44 (AUC: 0.765; p = 0.0001), white blood cell count > 12.21 (AUC: 0.688; p = 0.0001), hemoglobin < 11.2 (AUC: 0.611; p = 0.0103), and Charlson comorbidity index > 2 (AUC: 0.739; p = 0.0001). The use of antineoplastic drugs (OR: 4.502; p = 0.010) and increased values of the following were associated with an increased risk of mortality: urea (OR: 1.007; p = 0.024), C-reactive protein (OR: 1.005; p = 0.026), glucose (OR: 1.008; p = 0.001), and Charlson comorbidity index (OR: 1.198; p = 0.025). CONCLUSION Malignancy; liver cirrhosis; dialysis treatment; increased Charlson comorbidity index, urea, and C-reactive protein values and the use of antineoplastic drugs are associated with mortality.
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Affiliation(s)
- Seyran Bozkurt Babuş
- Emergency Medicine Department, Faculty of Medicine, Mersin University, Mersin, Turkey.
| | - Ataman Köse
- Emergency Medicine Department, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Semra Erdoğan
- Biostatistics and Medical Informatics Department, Faculty of Medicine, Mersin University Mersin, Mersin, Turkey
| | - Mesut Kiraz
- Emergency Medicine Department, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Fulya İyikesici
- Şanlıurfa Balıklıgöl Urfa State Hospıtal Emergency Service, Şanlıurfa, Turkey
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Development and Remodeling of Point-of-Care Ultrasound Education for Emergency Medicine Residents in Resource Limited Countries during the COVID-19 Pandemic. Tomography 2021; 7:721-733. [PMID: 34842824 PMCID: PMC8628902 DOI: 10.3390/tomography7040060] [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: 09/15/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultra-sound learning materials were useful tools which showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps, including the availability of handheld devices, as well as the re-modeling of the ultrasound rotation course, which should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade.
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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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Chen WL, Hsu CP, Wu PH, Chen JH, Huang CC, Chung JY. Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department. Medicine (Baltimore) 2021; 100:e24644. [PMID: 33592916 PMCID: PMC7870183 DOI: 10.1097/md.0000000000024644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.We conducted a retrospective cohort study in the ED of a university-affiliated medical center, to evaluate a centralized residency-based POCUS training course for ED residents, which included 12 core ultrasound applications, from July 2017 to June 2018. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. The use of POCUS (number of ultrasound studies performed divided by the number of patients each resident saw in 1 year) among ED residents, before and after the POCUS training course (July 2016-June 2017 and July 2018-June 2019), was calculated and analyzed using the Wilcoxon signed-rank test.Sixteen residents participated and completed the entire training course. The post-test score was significantly better than the pre-test score, by a median of 12 points (P = .04). Utilization of POCUS among the ED residents increased significantly, from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (P < .01), after completion of the entire training course. Increased POCUS scanning percentages over the cardiac tissue, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conducting a comprehensive POCUS education program may enhance POCUS utilization among residents in the ED.
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Affiliation(s)
- Wei-Lung Chen
- Department of Emergency Medicine, Cathay General Hospital
- Fu Jen Catholic University School of Medicine, Taipei
| | - Chan-Peng Hsu
- Department of Emergency Medicine, Hsinchu Cathay General Hospital, Hsinchu
| | - Po-Han Wu
- Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital
- Fu Jen Catholic University School of Medicine, Taipei
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital
- Fu Jen Catholic University School of Medicine, Taipei
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Mermiri M, Mavrovounis G, Chatzis D, Mpoutsikos I, Tsaroucha A, Dova M, Angelopoulou Z, Ragias D, Chalkias A, Pantazopoulos I. Critical emergency medicine and the resuscitative care unit. Acute Crit Care 2021; 36:22-28. [PMID: 33508185 PMCID: PMC7940106 DOI: 10.4266/acc.2020.00521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023] Open
Abstract
Critical emergency medicine is the medical field concerned with management of critically ill patients in the emergency department (ED). Increased ED stay due to intensive care unit (ICU) overcrowding has a negative impact on patient care and outcome. It has been proposed that implementation of critical care services in the ED can negate this effect. Two main Critical Emergency Medicine models have been proposed, the "resource intensivist" and "ED-ICU" models. The resource intensivist model is based on constant presence of an intensivist in the traditional ED setting, while the ED-ICU model encompasses the notion of a separate ED-based unit, with monitoring and therapeutic capabilities similar to those of an ICU. Critical emergency medicine has the potential to improve patient care and outcome; however, establishment of evidence-based protocols and a multidisciplinary approach in patient management are of major importance.
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Affiliation(s)
- Maria Mermiri
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | | | | | - Maria Dova
- Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Zacharoula Angelopoulou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Ragias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Comparison of Regularly Scheduled Ibuprofen Versus "Pro Re Nata" for Ankle Sprains in Children Treated in the Emergency Department: A Randomized Controlled Trial. Pediatr Emerg Care 2020; 36:559-563. [PMID: 33060555 DOI: 10.1097/pec.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We compared pain and degree of disability in patients with acute ankle sprains receiving regular scheduled ibuprofen versus pro re nata (PRN). METHODS This study is a randomized single-blinded controlled trial of children aged 7 to 17 years presenting with acute ankle sprain to an emergency department. Patients were randomized to receive 10 mg/kg of ibuprofen per dose (maximum 600 mg) every 6 hours regular scheduled versus PRN. Outcome measures included a 100-mm visual analog scale pain and degree of disability at day 4. A sample size of 72 children had a power of 80% to detect a clinically meaningful difference of 20 mm between the regular and PRN group. RESULTS We randomly assigned 99 patients to receive regular scheduled (n = 50) or PRN (n = 49) ibuprofen. Pain scores and degree of disability at day 4 showed no significant differences between groups. The rate of reported adverse effects was higher in the regular scheduled group (11.4% vs 9.5%) versus the PRN group. CONCLUSIONS Our study suggests that there is little benefit from routinely using a regular scheduled ibuprofen regimen for acute pediatric ankle sprains.
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Wenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:443-451. [PMID: 32734612 DOI: 10.1002/jcu.22894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We sought to understand current POCUS practices and comfort as well as assess opinions about POCUS across our medical system via a survey to guide program development. METHODS This study was conducted as a 19 question RedCap survey with multiple parts. Respondents were queried for demographics as well as experience with, attitudes toward, and clinical use of POCUS in common critical care scenarios. RESULTS The survey was completed by 343 individuals, a response rate of 30%. Most respondents "agreed" that POCUS is a needed skill and helped them provide safer care (78% and 86% agreement). Most faculty and trainees reported some POCUS training (62% and 88%) and at least weekly use. Trainees rated themselves more comfortable than faculty for most exam types. The majority of faculty rated their POCUS education as inadequate while trainees had mixed responses. CONCLUSIONS POCUS is a frequently used tool, yet users are less confident in their skills than expected. POCUS applications are viewed as needed for future practice but there is a substantial need for improved education among faculty and trainees. Pooling resources and sharing educational initiatives across multiple specialties may help improve POCUS implementation.
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Affiliation(s)
- Jesse Wenger
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Trevor C Steinbach
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - David Carlbom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reid Wd Farris
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Town
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
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Panebianco NL, Liu RB, Alerhand S, Au AK, Bailitz J, Chiem AT, Damewood SC, Friedman L, Gottlieb M, Lema PC, Lewiss RE, Lin J, Lin M, Liang Liu E, Magee MA, Nelson MJ, Sajed D, Situ‐LaCasse EH, Stolz L. Joint Recommendations and Resources for Clinical Ultrasound Education Amidst the COVID-19 Era. AEM EDUCATION AND TRAINING 2020; 4:438-442. [PMID: 33150291 PMCID: PMC7592817 DOI: 10.1002/aet2.10506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 05/28/2023]
Affiliation(s)
- Nova L. Panebianco
- From theDepartment of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Rachel B. Liu
- theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Stephen Alerhand
- theDepartment of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNJUSA
| | - Arthur K. Au
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - John Bailitz
- theDepartment of Emergency MedicineNorthwestern UniversityChicagoILUSA
| | - Alan T. Chiem
- theDepartment of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Sara C. Damewood
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Lucas Friedman
- theDepartment of Emergency MedicineUniversity of California at Riverside School of MedicineRiversideCAUSA
| | - Michael Gottlieb
- theDepartment of Emergency MedicineRush University Medical CenterChicagoILUSA
| | - Penelope C. Lema
- theDepartment of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Resa E. Lewiss
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Judy Lin
- theDepartment of Emergency MedicineMaimonides Medical CenterBrooklynNYUSA
| | - Maya Lin
- theDepartment of Emergency MedicineNew York Presbyterian–Brooklyn Methodist HospitalBrooklynNYUSA
| | - E. Liang Liu
- theDepartment of Emergency MedicineEmory UniversityAtlantaGAUSA
| | - Mark A. Magee
- theDepartment of Emergency MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPAUSA
| | - Mathew J. Nelson
- theDepartment of Emergency MedicineNorth Shore University HospitalManhassetNYUSA
| | - Dana Sajed
- theDepartment of Emergency MedicineLA County + USC Medical CenterLos AngelesCAUSA
| | - Elaine H. Situ‐LaCasse
- theDepartment of Emergency MedicineUniversity of Arizona/Banner University Medical Center–TucsonTucsonAZUSA
| | - Lori Stolz
- and theDepartment of Emergency MedicineUniversity of CincinnatiCincinnatiOHUSA
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Wood DB, Jordan J, Cooney R, Goldflam K, Bright L, Gottlieb M. Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med 2020; 21:999-1007. [PMID: 32726275 PMCID: PMC7390555 DOI: 10.5811/westjem.2020.5.46762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022] Open
Abstract
Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.
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Affiliation(s)
- D Brian Wood
- St. Joseph's Medical Center, Department of Emergency Medicine, Stockton, California
| | - Jaime Jordan
- Ronald Reagan UCLA Medical Center, David Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Rob Cooney
- Geisinger Commonwealth School of Medicine, Department of Emergency Medicine, Scranton, Pennsylvania
| | - Katja Goldflam
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | - Leah Bright
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Li J, Roosevelt G, McCabe K, Preotle J, Pereira F, Takayesu JK, Porter JJ, Monuteaux M, Bachur RG. Critically Ill Pediatric Case Exposure During Emergency Medicine Residency. J Emerg Med 2020; 59:278-285. [PMID: 32536497 DOI: 10.1016/j.jemermed.2020.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Eighty-eight percent of pediatric emergency department (ED) visits occur in general EDs. Exposure to critically ill children during emergency medicine (EM) training has not been well described. OBJECTIVE The objective was to characterize the critically ill pediatric EM case exposure among EM residents. METHODS This is a secondary analysis of a multicenter retrospective review of pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at four U.S. EM training programs. The per-resident exposure to Emergency Severity Index (ESI) Level 1 pediatric patients was measured. Resident-level counts of pediatric patients were measured; specific counts were classified by age and Pediatric Emergency Care Applied Network diagnostic categories. RESULTS There were 31,552 children seen by 51 residents across all programs; 434 children (1.3%) had an ESI of 1. The median patient age was 8 years (interquartile range [IQR] 3-12 years). The median overall pediatric critical case exposure per resident was 6 (IQR 3-12 cases). The median trauma and medical exposure was 2 (IQR 0-3) and 3 (IQR 2-10), respectively. For 13 out of 20 diagnostic categories, at least 50% of residents did not see any critical care case in that category. Sixty-eight percent of residents saw 10 or fewer critically ill cases by the end of training. CONCLUSION Pediatric critical care exposure during EM training is very limited. These findings underscore the importance of monitoring trainees' case experience to inform program-specific curricula and to develop strategies to increase exposure and resident entrustment, as well as further research in this area.
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Affiliation(s)
- Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Genie Roosevelt
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; University of Colorado School of Medicine, Denver, Colorado
| | - Kerry McCabe
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Jane Preotle
- Department of Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island; Alpert Medical School of Brown University, Providence, Rhode Island
| | - Faria Pereira
- Division of Emergency Medicine, Texas Children's Hospital, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - James K Takayesu
- Division of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John J Porter
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Richard G Bachur
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
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14
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Beeson MS, Ankel F, Bhat R, Broder JS, Dimeo SP, Gorgas DL, Jones JS, Patel V, Schiller E, Ufberg JW, Keehbauch JN. The 2019 Model of the Clinical Practice of Emergency Medicine. J Emerg Med 2020; 59:96-120. [PMID: 32475725 DOI: 10.1016/j.jemermed.2020.03.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Michael S Beeson
- American Board of Emergency Medicine, East Lansing, Michigan; Summa Health, Akron, Ohio
| | - Felix Ankel
- American Board of Emergency Medicine, East Lansing, Michigan; Regions Hospital, St. Paul, Minnesota; Health Partners Institute, Bloomington, Minnesota; University of Minnesota Medical School, Minneapolis, Minnesota
| | - Rahul Bhat
- American College of Emergency Physicians, Irving, Texas; Georgetown University School of Medicine, Washington, District of Columbia; Medstar Washington Hospital Center, Washington, District of Columbia
| | - Joshua S Broder
- Society for Academic Emergency Medicine, Des Plaines, Illinois; Duke University School of Medicine, Durham, North Carolina
| | - Sara Paradise Dimeo
- Emergency Medicine Residents' Association, Irving, Texas; Prisma Health-Upstate, Greenville, South Carolina; University of South Carolina, Greenville, South Carolina
| | - Diane L Gorgas
- Residency Review Committee for Emergency Medicine, Chicago, Illinois; Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Health Sciences Center for Global Health, The Ohio State University, Columbus, Ohio
| | - Jonathan S Jones
- American Academy of Emergency Medicine, Milwaukee, Wisconsin; College of Osteopathic Medicine, William Carey University, Jackson, Mississippi
| | - Viral Patel
- Society for Academic Emergency Medicine, Des Plaines, Illinois; University of Massachusetts, Worcester, Massachusetts
| | - Elizabeth Schiller
- American College of Emergency Physicians, Irving, Texas; Saint Francis Hospital and Medical Center, Hartford, Connecticut; University of Connecticut Integrated Program in Emergency Medicine, Farmington, Connecticut
| | - Jacob W Ufberg
- Council of Emergency Medicine Residency Directors, Irving, Texas; Department of Emergency Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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15
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Constantine E, Levine M, Abo A, Arroyo A, Ng L, Kwan C, Baird J, Shefrin AE. Core Content for Pediatric Emergency Medicine Ultrasound Fellowship Training: A Modified Delphi Consensus Study. AEM EDUCATION AND TRAINING 2020; 4:130-138. [PMID: 32313859 PMCID: PMC7163196 DOI: 10.1002/aet2.10365] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) fellowships exist to provide learners with expertise in ultrasound (US) education, administration, and research oversight. Currently, there are no standardized goals or objectives for these programs, resulting in considerable variability in PEM POCUS fellowship training. METHODS A modified Delphi survey of PEM and general emergency medicine (EM) POCUS experts in Canada and the United States was conducted to obtain consensus regarding the most important curricular components of a PEM POCUS fellowship training program. Participants were solicited from the P2 Network mailing list and from PEM and EM POCUS fellowship directors listed on the Society of Clinical Ultrasound Fellowships and the Canadian Society of POCUS-EM Fellowships websites. Curricular components considered as part of the survey included US skills, educational skills, administrative skills, and research requirements. Consensus was considered to have been reached when ≥80% of respondents agreed to either include or exclude the component in fellowship training. RESULTS Round 1 of the survey was sent to 311 participants. A total of 118 (37.9%) completed eligibility for the survey, and 92 (78.0%) met eligibility criteria. Of those, 80 (67.8% of eligible participants) completed the first round of the survey. Round 2 of the survey was sent to those who completed part 1, and 64 (80.0%) completed that round. During Round 1, consensus was achieved for 15 of 75 US applications, seven of seven educational skills, nine of 11 administrative skills, and four of six research requirements. In Round 2 of the survey, consensus was reached on two additional US skills, but no additional administrative skills or research requirements. CONCLUSIONS With a consensus-building process, the core content for PEM POCUS fellowship training was defined. This can help POCUS educators formulate standardized curricula to create consistent training in POCUS fellowship graduates.
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Affiliation(s)
| | - Marla Levine
- University of Texas at AustinDell Medical SchoolDell Children's Medical Center of Central TexasAustinTX
| | - Alyssa Abo
- George Washington University School of Medicine and Health SciencesWashingtonDC
| | - Alex Arroyo
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNY
| | - Lorraine Ng
- Division of Pediatric Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNY
| | - Charisse Kwan
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Janette Baird
- Warren Alpert School of Medicine at Brown University and Injury Prevention CenterProvidenceRI
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16
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Turner JS, Courtney RD, Sarmiento E, Ellender TJ. Frequency of safety net errors in the emergency department: Effect of patient handoffs. Am J Emerg Med 2020; 42:188-191. [PMID: 32151369 DOI: 10.1016/j.ajem.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine physician awareness of abnormal vital signs and key clinical interventions (oxygen provision, intravenous access) in the emergency department, and to measure the effect of patient handoffs on this awareness. METHODS This was a prospective observational study at two large, urban, academic emergency departments. Emergency department physicians were asked the following about each of the physician's patients: 1) the number of IV lines, 2) whether the patient was on supplemental oxygen, and 3) whether the patient had any abnormal vital signs. Physicians were blind to the nature of the study prior to enrollment. Error rates between physician responses and actual patient status were calculated, and logistic regression, adjusted for physician clustering, was used to calculate association of errors with multiple situational factors, including handoff status. RESULTS We analyzed 463 patient encounters from 74 physicians. Physicians missed abnormal vital signs in 19.4% of encounters. They made errors in oxygen status and number of IV lines in 16.6% and 35.8% of encounters, respectively. Physicians were significantly more likely to make all types of errors on patients who had undergone handoff as opposed to their primary patients. CONCLUSION Emergency physicians make frequent errors regarding awareness of their patients' vital signs, oxygen and vascular status and patient handoffs are associated with an increased frequency of such errors.
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Affiliation(s)
- Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
| | - Rachel D Courtney
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America
| | - Elisa Sarmiento
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
| | - Timothy J Ellender
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
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17
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Filler L, Orosco D, Rigdon D, Mitchell C, Price J, Lotz S, Stowell JR. Evaluation of a novel curriculum on point-of-care ultrasound competency and confidence. Emerg Radiol 2019; 27:37-40. [PMID: 31485848 DOI: 10.1007/s10140-019-01726-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) education is a requirement of graduate medical education in EM. Milestones have been established to assess resident US competency. However, the delivery of POCUS education has not been standardized. This study aims to evaluate the impact of implementing a longitudinal, structured POCUS curriculum during EM residency on trainee competency and confidence. METHODS A prospective study of PGY-3 trainees before and after implementation of a novel POCUS curriculum was performed over an 18-month period at an EM residency training program. Curriculum design included longitudinal POCUS application-based monthly electronic content, bi-monthly residency conference sessions, and hands-on rotations. PGY-3 resident's POCUS knowledge was assessed with a 38-question multiple-choice and image-based exam. Further, PGY-3 residents were surveyed regarding POCUS confidence. Survey results evaluated provider confidence, satisfaction with the novel curriculum, and overall perception of POCUS utility scored on a 1 (low) to 5 (high) scale. Results were evaluated using an unpaired t test for data analysis. RESULTS Mean quiz scores of 8 pre-curriculum PGY-3 residents (84%; 95%CI 78.46-89.54) were not significantly different when compared with 13 post-curriculum PGY-3 residents (82%; 95%CI 77.11-86.89) (p = 0.6126). Survey results for pre-curriculum trainees across each section were 4.13 (95%CI 3.91-4.35), 3.68 (95%CI 3.32-4.04), and 4.33 (95%CI 4.06-4.6). Results for post-curriculum trainees trended higher for each section at 4.22 (95%CI 4.04-4.40) (p = 0.4738), 3.84 (95%CI 3.52-4.16) (p = 0.5279), and 4.49 (95%CI 4.21-4.77) (p = 0.4534). CONCLUSIONS Implementation of a structured, longitudinal POCUS curriculum resulted in a trend towards improved trainee confidence, satisfaction, and perception of POCUS. Future studies are needed to identify the optimal structure for POCUS educational content delivery and competency assessment for EM resident providers.
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Affiliation(s)
- Levi Filler
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.
| | - Daniel Orosco
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Daniel Rigdon
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Carl Mitchell
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.,Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA.,Department of Emergency Medicine, Creighton University School of Medicine, Phoenix, AZ, USA
| | - James Price
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Scott Lotz
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Jeffrey R Stowell
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.,Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA.,Department of Emergency Medicine, Creighton University School of Medicine, Phoenix, AZ, USA
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18
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Poniatowski PA, Dugosh JW, Baranowski RA, Arnold G, Lipner RS, Dec GW, Green MM. Incorporating Physician Input Into a Maintenance of Certification Examination: A Content Validity Tool. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1369-1375. [PMID: 31460935 DOI: 10.1097/acm.0000000000002727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE As part of the American Board of Internal Medicine's (ABIM's) continuing effort to update its Maintenance of Certification (MOC) program, a content validity tool was used to conduct structured reviews of MOC exam blueprints (i.e., test specification tables) by the physician community. Results from the Cardiovascular Disease MOC blueprint review are presented to illustrate the process ABIM conducted for several internal medicine disciplines. METHOD Ratings of topic frequency and importance were collected from cardiologists in 2016 using a three-point scale (low, medium, high). The web-based survey instrument presented 188 blueprint topic descriptions, each combined with five patient-related tasks (e.g., diagnosis, treatment). Descriptive statistics and chi-square analysis were employed. RESULTS Responses from 441 review participants were analyzed. Frequency and importance ratings were aggregated as a composite statistic representing clinical relevance, and exam assembly criteria were modified to select questions, or items, addressing clinically relevant content only. Specifically, ≥ 88% of exam items now address high-importance topics, including ≤ 15% on topics that are also low frequency; and ≤ 12% of exam items now address medium-importance topics, including ≤ 3% on topics that are also low frequency. The updated blueprint has been published for test takers and provides enhanced information on content that would and would not be tested in subsequent examinations. It is linked to more detailed feedback that examinees receive on items answered incorrectly. CONCLUSIONS The blueprint review garnered valuable feedback from the physician community and provided new evidence for the content validity of the Cardiovascular Disease MOC exam.
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Affiliation(s)
- Paul A Poniatowski
- P.A. Poniatowski is former vice president, Test Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. J.W. Dugosh is vice president, Test Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. R.A. Baranowski is director, Test Development Operations, American Board of Internal Medicine, Philadelphia, Pennsylvania. G. Arnold is former senior statistician, Research and Innovations, American Board of Internal Medicine, Philadelphia, Pennsylvania. R.S. Lipner is senior vice president, Assessment and Research, American Board of Internal Medicine, Philadelphia, Pennsylvania. G.W. Dec Jr is chief emeritus, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, and Roman W. DeSanctis Professor of Medicine, Harvard Medical School, Boston, Massachusetts. M.M. Green is senior associate dean for Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Shefrin AE, Warkentine F, Constantine E, Toney A, Uya A, Doniger SJ, Sivitz AB, Horowitz R, Kessler D. Consensus Core Point-of-care Ultrasound Applications for Pediatric Emergency Medicine Training. AEM EDUCATION AND TRAINING 2019; 3:251-258. [PMID: 31360818 PMCID: PMC6637013 DOI: 10.1002/aet2.10332] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) physicians have variably incorporated point-of-care ultrasound (POCUS) into their practice. Prior guidelines describe the scope of POCUS practice for PEM physicians; however, consensus does not yet exist about which applications should be prioritized and taught as fundamental skills for PEM trainees. Members of the PEM POCUS Network (P2Network) conducted a consensus-building process to determine which applications to incorporate into PEM fellowship training. METHODS A multinational group of experts in PEM POCUS was recruited from the P2Network and greater PEM POCUS community if they met the following criteria: performed over 1,000 POCUS scans and had at least 3 years of experience teaching POCUS to PEM fellows, were a local academic POCUS leader, or completed a formal PEM POCUS fellowship. Experts rated 60 possible PEM POCUS applications for their importance to include as part of a PEM fellowship curriculum using a modified Delphi consensus-building technique. RESULTS In round 1, 66 of 92 (72%) participants responded to an e-mail survey of which 48 met expert criteria and completed the survey. Consensus was reached to include 18 items in a PEM fellowship curriculum and to exclude two items. The 40 remaining items and seven additional items were considered in round 2. Thirty-seven of 48 (77%) experts completed round 2 reaching consensus to include three more items and exclude five. The remaining 39 items did not reach consensus for inclusion or exclusion. CONCLUSION Experts reached consensus on 21 core POCUS applications to include in PEM fellowship curricula.
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Affiliation(s)
- Allan Evan Shefrin
- Department of Pediatrics and Emergency MedicineUniversity of OttawaOttawaONCanada
| | - Fred Warkentine
- Department of PediatricsUniversity of LouisvilleLouisvilleKY
| | - Erika Constantine
- Division of Pediatric Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRI
| | - Amanda Toney
- Department of Emergency MedicineDenver Health Medical CenterUniversity of Colorado School of MedicineAuroraCO
| | - Atim Uya
- Department of PediatricsUniversity of California at San DiegoSan DiegoCA
| | - Stephanie J. Doniger
- Department of Emergency MedicineNew York University WinthropMineolaNY
- St. Christopher's Hospital for ChildrenPhiladelphiaPA
| | - Adam Brand Sivitz
- Department of Emergency MedicineNewark Beth Israel Medical CenterChildren's Hospital of New JerseyNewarkNJ
| | - Russ Horowitz
- Department of Pediatrics Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - David Kessler
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNY
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20
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Li J, Roosevelt G, McCabe K, Preotle J, Pereira F, Takayesu JK, Monuteaux M, Bachur RG. Pediatric Case Exposure During Emergency Medicine Residency. AEM EDUCATION AND TRAINING 2018; 2:317-327. [PMID: 30386842 PMCID: PMC6194046 DOI: 10.1002/aet2.10130] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 05/12/2023]
Abstract
OBJECTIVE While emergency medicine (EM) physicians treat the majority of pediatric EM (PEM) patients in the United States, little is known about their PEM experience during training. The primary objective was to characterize the pediatric case exposure and compare to established EM residency training curricula among EM residents across five U.S. residency programs. METHODS We performed a multicenter medical record review of all pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at five U.S. EM training programs. Resident-level counts of pediatric patients were measured and specific counts were classified by the 2016 Model of Clinical Practice of Emergency Medicine (MCP) and Pediatric Emergency Care Applied Research Network (PECARN) diagnostic categories. We assessed variability between residents and between programs. RESULTS A total of 36,845 children were managed by 68 residents across all programs. The median age was 6 years. The median number of patients per resident was 660 with an interquartile range of 336. The most common PECARN diagnostic categories were trauma, gastrointestinal, and respiratory disease. Thirty-two core MCP diagnoses (43% of MCP list) were not seen by at least 50% of the residents. We found statistically significant variability between programs in both PECARN diagnostic categories (p < 0.01) and MCP diagnoses (p < 0.01). CONCLUSION There is considerable variation in the number of pediatric patients and the diagnostic case volume seen by EM residents. The relationship between this case variability and competence upon graduation is unknown; further investigation is warranted to better inform program-specific curricula and to guide training requirements in EM.
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Affiliation(s)
- Joyce Li
- Division of Emergency MedicineBoston Children's HospitalBostonMA
- Department of Emergency Medicine and PediatricsHarvard Medical SchoolBostonMA
| | - Genie Roosevelt
- Denver Health Medical CenterDepartment of Emergency MedicineUniversity of Colorado School of MedicineDenverCO
| | - Kerry McCabe
- Boston Medical CenterDepartment of Emergency MedicineBoston University School of MedicineBostonMA
| | - Jane Preotle
- Hasbro Children's HospitalDepartment of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRI
| | - Faria Pereira
- Texas Children's HospitalDivision of Emergency MedicineBaylor College of MedicineHoustonTX
| | - James K. Takayesu
- Massachusetts General HospitalDivision of Emergency MedicineHarvard Medical SchoolBostonMA
| | - Michael Monuteaux
- Division of Emergency MedicineBoston Children's HospitalBostonMA
- Department of Emergency Medicine and PediatricsHarvard Medical SchoolBostonMA
| | - Richard G. Bachur
- Division of Emergency MedicineBoston Children's HospitalBostonMA
- Department of Emergency Medicine and PediatricsHarvard Medical SchoolBostonMA
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21
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Stowell JR, Kessler R, Lewiss RE, Barjaktarevic I, Bhattarai B, Ayutyanont N, Kendall JL. Critical care ultrasound: A national survey across specialties. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:167-177. [PMID: 29131347 DOI: 10.1002/jcu.22559] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Management of the critically ill patient requires rapid assessment and differentiation. Point-of-care ultrasound (POCUS) improves diagnostic accuracy and guides resuscitation. This study sought to describe the use of critical care related POCUS amongst different specialties. METHODS This study was conducted as an online 18-question survey. Survey questions queried respondent demographics, preferences for POCUS use, and barriers to implementation. RESULTS 2735 recipients received and viewed the survey with 416 (15.2%) responses. The majority of respondents were pulmonary and critical care medicine (62.5%) and emergency medicine (19.9%) providers. Respondents obtained training through educational courses (26.5%), fellowship (23.9%), residency (21.6%), or self-guided learning (17.2%). POCUS use was common for diagnostic and procedural guidance. Emergency medicine providers were more likely to utilize POCUS to evaluate undifferentiated hypotension (98.5%, P < .001), volume status and fluid responsiveness (88.2%, P = .005), and cardiopulmonary arrest (94.1%, P < .001) compared to other specialties. Limited training, competency, or credentialing were the most common barriers, in up to 39.4% of respondents. CONCLUSION Study respondents utilize POCUS in a variety of clinical applications. However, a disparity in utilization still exists among clinicians who care for critically ill patients. Overcoming barriers, such as a lack of formalized training, competency, or credentialing, may lead to increased utilization.
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Affiliation(s)
- Jeffrey R Stowell
- Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, Arizona
- Department of Emergency Medicine, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Ross Kessler
- Department of Emergency Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Resa E Lewiss
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Bikash Bhattarai
- Department of Grants and Research, Maricopa Integrated Health System, Phoenix, Arizona
- Department of Medicine Administration, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Napatkamon Ayutyanont
- Department of Grants and Research, Maricopa Integrated Health System, Phoenix, Arizona
- Department of Medicine Administration, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - John L Kendall
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado
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22
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Murray M, McCarthy S. Review article: A systematic review of emergency department incident classification frameworks. Emerg Med Australas 2017; 30:293-308. [PMID: 29024416 DOI: 10.1111/1742-6723.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
Abstract
As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors.
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Affiliation(s)
- Matthew Murray
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Sally McCarthy
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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23
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Abstract
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.
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24
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Counselman FL, Babu K, Edens MA, Gorgas DL, Hobgood C, Marco CA, Katz E, Rodgers K, Stallings LA, Wadman MC, Beeson MS, Keehbauch JN. The 2016 Model of the Clinical Practice of Emergency Medicine. J Emerg Med 2017; 52:846-849. [PMID: 28351510 DOI: 10.1016/j.jemermed.2017.01.040] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Francis L Counselman
- American Board of Emergency Medicine, East Lansing, Michigan; Department of Emergency Medicine, Eastern Virginia Medical School, and Emergency Physicians of Tidewater, Norfolk, Virginia
| | - Kavita Babu
- Society for Academic Emergency Medicine, Des Plaines, Illinois; Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mary Ann Edens
- American College of Emergency Physicians, Irving, Texas; Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana
| | - Diane L Gorgas
- Residency Review Committee for Emergency Medicine, Chicago, Illinois; Department of Emergency Medicine, Ohio State University, Columbus, Ohio
| | - Cherri Hobgood
- Society for Academic Emergency Medicine, Des Plaines, Illinois; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Catherine A Marco
- American Board of Emergency Medicine, East Lansing, Michigan; Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Eric Katz
- Council of Emergency Medicine Residency Directors, Irving, Texas; Department of Emergency Medicine, Maricopa Integrated Health Systems, Phoenix, Arizona
| | - Kevin Rodgers
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana; American Academy of Emergency Medicine, Milwaukee, Wisconsin
| | - Leonard A Stallings
- Emergency Medicine Residents' Association, Irving, Texas; Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Michael C Wadman
- American College of Emergency Physicians, Irving, Texas; Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Smalley CM, Thiessen M, Byyny R, Dorey A, McNair B, Kendall JL. Number of Weeks Rotating in the Emergency Department Has a Greater Effect on Ultrasound Milestone Competency Than a Dedicated Ultrasound Rotation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:335-343. [PMID: 27943410 DOI: 10.7863/ultra.15.12044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Ultrasound (US) is vital to modern emergency medicine (EM). Across residencies, there is marked variability in US training. The "goal-directed focused US" part of the Milestones Project states that trainees must correctly acquire and interpret images to achieve a level 3 milestone. Standardized methods by which programs teach these skills have not been established. Our goal was to determine whether residents could achieve level 3 with or without a dedicated US rotation. METHODS Thirty-three first- and second-year residents were assigned to control (no rotation) and intervention (US rotation) groups. The intervention group underwent a 2-week curriculum in vascular access, the aorta, echocardiography, focused assessment with sonography for trauma, and pregnancy. To test acquisition, US-trained emergency medicine physicians administered an objective structured clinical examination. To test interpretation, residents had to identify normal versus abnormal findings. Mixed-model logistic regression tested the association of a US rotation while controlling for confounders: weeks in the emergency department (ED) as a resident, medical school US rotation, and postgraduate years. RESULTS For image acquisition, medical school US rotation and weeks in the ED as a resident were significant (P = .03; P = .04) whereas completion of a US rotation and postgraduate years were not significant. For image interpretation, weeks in the ED as a resident was the only significant predictor of performance (P = .002) whereas completion of a US rotation and medical school US rotation were not significant. CONCLUSIONS To achieve a level 3 milestone, weeks in the ED as a resident were significant for mastering image acquisition and interpretation. A dedicated US rotation did not have a significant effect. A medical school US rotation had a significant effect on image acquisition but not interpretation. Further studies are needed to best assess methods to meet US milestones.
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Affiliation(s)
| | - Molly Thiessen
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Richard Byyny
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Alyrene Dorey
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Bryan McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, Colorado, USA
| | - John L Kendall
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
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Counselman FL, Beeson MS, Marco CA, Adsit SK, Harvey AL, Keehbauch JN, Counselman FL, Babu K, Edens MA, Gorgas DL, Hobgood C, Marco CA, Katz E, Rodgers K, Stallings L, Wadman MC. Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present. Acad Emerg Med 2017; 24:257-264. [PMID: 27859987 DOI: 10.1111/acem.13137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/07/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Abstract
The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today.
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Affiliation(s)
- Francis L. Counselman
- Department of Emergency Medicine Eastern Virginia Medical School and Emergency Physicians of Tidewater Norfolk VA
| | - Michael S. Beeson
- Department of Emergency Medicine Cleveland Clinic–Akron General Medical Center Akron Ohio
| | - Catherine A. Marco
- Department of Emergency Medicine Wright State University Boonshoft School of Medicine Dayton Ohio
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Beeson MS. The Emergency Medicine Milestones: With Experience Comes Suggestions to Improve. Acad Emerg Med 2016; 23:1434-1436. [PMID: 27428572 DOI: 10.1111/acem.13055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael S. Beeson
- Department of Emergency Medicine; Cleveland Clinic Foundation Akron General Medical Center; Akron OH
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How do emergency medicine residency core faculty obtain their ultrasound training for credentialing? Am J Emerg Med 2015; 33:1832-4. [PMID: 26417861 DOI: 10.1016/j.ajem.2015.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 11/23/2022] Open
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Abstract
April 2015 marks the publication of the first national guideline regarding point-of-care ultrasound by pediatric emergency medicine physicians. The joint statement by the American Academy of Pediatrics, Society for Academic Emergency Medicine, American College of Emergency Physicians, and World Interactive Network Focused on Critical Ultrasound provides a framework on which pediatric emergency physicians can develop the necessary skills to use point-of-care ultrasound effectively and responsibly.
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Cardamore R, Nemeth J, Meyers C. Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centres. CAN J EMERG MED 2015; 14:14-9. [DOI: 10.2310/8000.2011.110475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
ABSTRACT
Objectives:
To quantify the current availability and use of bedside emergency department ultrasonography (EDUS) for blunt trauma at Canadian pediatric centres and to identify any perceived barriers to the use of bedside EDUS in such centres.
Methods:
An electronic survey was sent to 162 pediatric emergency physicians and 12 site directors from the 12 pediatric emergency departments across Canada.
Results:
Ninety-two percent (11 of 12) of centres completed the survey. The individual physician response rate was 65% (106 of 162), with 100% of site directors responding. Ultrasound machines were available in 45% (5 of 11) of centres. Forty-two percent (32 of 77) of emergency physicians working in equipped pediatric centres used bedside EDUS to evaluate blunt abdominal trauma (BAT). In the subgroup of staff who also worked at adults sites, the frequency of ultrasonography use for the evaluation of pediatric BAT was 75%. In the 55% (6 of 11) of centres without ultrasonography, 88% of staff intend to incorporate its use in the future and 81% indicated that they believed the incorporation of ultrasonography would have a positive impact on patient care. The main perceived barriers to the use of ultrasonography in the evaluation of BAT were a lack of training (41%) and a lack of equipment (26%).
Conclusion:
Bedside EDUS is currently used in almost half of pediatric trauma centres, a frequency that is significantly lower than adult centres. Physicians in pediatric centres who use ultrasonography report that it has a high utility, and a great majority of physicians at pediatric centres without EDUS plan to incorporate it in the future. The main reported barriers to its use are a lack of training and a lack of equipment availability.
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Lane N, Lahham S, Joseph L, Bahner DP, Fox JC. Ultrasound in medical education: listening to the echoes of the past to shape a vision for the future. Eur J Trauma Emerg Surg 2015; 41:461-7. [PMID: 26038053 DOI: 10.1007/s00068-015-0535-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/18/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE Ultrasound in medical education has seen a tremendous growth over the last 10-20 years but ultrasound technology has been around for hundreds of years and sound has an even longer scientific history. The development of using sound and ultrasound to understand our body and our surroundings has been a rich part of human history. From the development of materials to produce piezoelectric conductors, ultrasound has been used and improved in many industries and medical specialties. METHODS As diagnostic medical ultrasound has improved its resolution and become more portable, various specialties from radiology, cardiology, obstetrics and more recently emergency, critical care and proceduralists have found the added benefits of using ultrasound to safely help patients. The past advancements in technology have established the scaffold for the possibilities of diagnostic ultrasound's use in the present and future. RESULTS A few medical educators have integrated ultrasound into medical school while a wealth of content exists online for learning ultrasound. Twenty-first century learners prefer blended learning where material can be reviewed online and personalize the education on their own time frame. This material combined with hands-on experience and mentorship can be used to develop learners' aptitude in ultrasound. CONCLUSIONS As educators embrace this ultrasound technology and integrate it throughout the medical education journey, collaboration across specialties will synthesize a clear path forward when needs and resources are paired with vision and a strategic plan.
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Affiliation(s)
- N Lane
- Irvine School of Medicine, University of California, Irvine, USA
| | - S Lahham
- Irvine School of Medicine, University of California, Irvine, USA
| | - L Joseph
- Irvine School of Medicine, University of California, Irvine, USA
| | - D P Bahner
- The Ohio State University, 756 Prior Hall, 376 W. 10th Avenue, Columbus, OH, 43210, USA.
| | - J C Fox
- Irvine School of Medicine, University of California, Irvine, USA.
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Marin JR, Lewiss RE. Point-of-care Ultrasonography by Pediatric Emergency Medicine Physicians. Acad Emerg Med 2015; 22:623-4. [PMID: 25899848 DOI: 10.1111/acem.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer R. Marin
- Department of Pediatrics; University of Pittsburgh School of Medicine; Pittsburgh PA
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Resa E. Lewiss
- Department of Emergency Medicine University of Colorado School of Medicine; Denver CO
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Abstract
Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.
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Lewiss RE, Hayden GE, Murray A, Liu YT, Panebianco N, Liteplo AS. SonoGames: an innovative approach to emergency medicine resident ultrasound education. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1843-1849. [PMID: 25253832 DOI: 10.7863/ultra.33.10.1843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
SonoGames was created by the Academy of Emergency Ultrasound for the 2012 annual meeting of the Society for Academic Emergency Medicine. The assessment of resident knowledge and of the performance of point-of-care ultrasound examinations is an integral component of ultrasound education and is required in emergency medicine residency training. With that in mind, game organizers sought to assess and improve emergency medicine residents' point-of-care ultrasound knowledge, hands-on skills, and integration of knowledge into clinical decision making. SonoGames is an annual 4-hour competition consisting of 3 rounds. In this article, we provide a description of SonoGames and provide a blueprint for an effective and successful educational event.
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Affiliation(s)
- Resa E Lewiss
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
| | - Geoffrey E Hayden
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
| | - Alice Murray
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
| | - Yiju Teresa Liu
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
| | - Nova Panebianco
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
| | - Andrew S Liteplo
- Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, New York, New York USA (R.E.L.); Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina USA (G.E.H.); Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts USA (A.M.); Department of Emergency Medicine, George Washington University, Washington, DC USA (Y.T.L.); Department of Emergency Medicine, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania USA (N.P.); and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA (A.S.L.)
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Kabrhel C, Rempell JS, Avery LL, Dudzinski DM, Weinberg I. Case records of the Massachusetts General Hospital. Case 29-2014. A 60-year-old woman with syncope. N Engl J Med 2014; 371:1143-50. [PMID: 25229919 DOI: 10.1056/nejmcpc1403307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Counselman FL, Borenstein MA, Chisholm CD, Epter ML, Khandelwal S, Kraus CK, Luber SD, Marco CA, Promes SB, Schmitz G, Keehbauch JN. The 2013 Model of the Clinical Practice of Emergency Medicine. Acad Emerg Med 2014; 21:574-98. [PMID: 24842511 DOI: 10.1111/acem.12373] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine.
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Affiliation(s)
| | | | | | | | | | - Chadd K. Kraus
- The Emergency Medicine Residents' Association; Dallas TX
| | | | | | - Susan B. Promes
- The Residency Review Committee for Emergency Medicine; Chicago IL
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Lewiss RE, Tayal VS, Hoffmann B, Kendall J, Liteplo AS, Moak JH, Panebianco N, Noble VE. The core content of clinical ultrasonography fellowship training. Acad Emerg Med 2014; 21:456-61. [PMID: 24730409 DOI: 10.1111/acem.12349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 07/05/2013] [Accepted: 12/02/2013] [Indexed: 11/26/2022]
Abstract
The purpose of developing a core content for subspecialty training in clinical ultrasonography (US) is to standardize the education and qualifications required to provide oversight of US training, clinical use, and administration to improve patient care. This core content would be mastered by a fellow as a separate and unique postgraduate training, beyond that obtained during an emergency medicine (EM) residency or during medical school. The core content defines the training parameters, resources, and knowledge of clinical US necessary to direct clinical US divisions within medical specialties. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear in future examinations. This article describes the development of the core content and presents the core content in its entirety.
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Affiliation(s)
- Resa E. Lewiss
- The Department of Emergency Medicine; St. Luke's Roosevelt of Mount Sinai Hospital; New York NY
| | - Vivek S. Tayal
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - Beatrice Hoffmann
- The Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
| | - John Kendall
- The Department of Emergency Medicine; Denver Health Medical Center; University of Colorado School of Medicine; Denver CO
| | - Andrew S. Liteplo
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - James H. Moak
- The Department of Emergency Medicine; University of Virginia; Charlottesville VA
| | - Nova Panebianco
- The Department of Emergency Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Vicki E. Noble
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
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Conroy MJ, Weingart GS, Carlson JN. Impact of checklists on peri-intubation care in ED trauma patients. Am J Emerg Med 2014; 32:541-4. [PMID: 24637135 DOI: 10.1016/j.ajem.2014.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/24/2014] [Accepted: 02/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Checklists have successfully been used in intensive care units (ICUs) to improve metrics of critical care. Proper peri-intubation care including use of appropriate induction agents and postintubation sedation is crucial when performing endotracheal intubation (ETI) on critically ill patients, especially in the emergency department (ED). We sought to evaluate the impact of checklists on peri-intubation care in ED trauma patients. METHODS We performed a retrospective review of all trauma patients intubated in the ED of an urban, level 1 academic center from November 2010 to October 2012. As part of a quality improvement project, a peri-intubation checklist was instituted on November 1, 2011 to guide peri-intubation care. Using a predesign and postdesign, we compared peri-intubation parameters using parametric and nonparametric statistics when appropriate to evaluate the impact of a checklist on peri-intubation care. We also evaluated outcome measures including mortality and lengths of stay. RESULTS During the 2-year study period, 187 trauma patients underwent ETI in the ED, 90 prechecklist and 97 postchecklist. Rapid sequence intubation (RSI) use was greater with the checklist than without (90.7% vs 75.6%, P=.005). No difference was found between the number of ETI attempts per patient, hemodynamic parameters (heart rate, blood pressure, and oxygen saturation), postintubation anxiolysis, median number of ventilator days, length of ED stay, length of ICU stay, or mortality. CONCLUSION Peri-intubation checklists result in higher rates of RSI in ED trauma patients but do not alter other measured metrics of peri-intubation care.
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Affiliation(s)
- Mark J Conroy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gregory S Weingart
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jestin N Carlson
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA.
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Oktay C, Eray O, Cete Y, Bozan H. Ketamine is still safe without concurrent midazolam and atropine for pediatric procedures in the emergency department. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/1568569054729517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hajimaghsoudi M, Jalili M, Mokhtari M, Nejati A, Mesbahi J, Paydary K. Naproxen Twice Daily Versus as Needed (PRN) Dosing: Efficacy and Tolerability for Treatment of Acute Ankle Sprain, a Randomized Clinical Trial. Asian J Sports Med 2013; 4:249-55. [PMID: 24799999 PMCID: PMC3977208 DOI: 10.5812/asjsm.11411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 06/16/2013] [Indexed: 12/26/2022] Open
Abstract
Purpose This study was conducted to compare the efficacy and safety of naproxen 500 mg twice daily (BID) versus naproxen 500 mg as needed (PRN) for treatment of ankle sprain. Methods In this seven-day, randomized, parallel group trial, 135 patients with ankle sprain occurring less than 48 hours prior to the first dose of study medication were randomized to receive naproxen 500 mg BID (67 patients) and naproxen 500 mg as needed (PRN) (68 patients). The ankle pain was assessed at rest and on full weight bearing using Numeric Rating Scale (NRS) from 0 (no pain) to 10 (the worst imaginable pain). Ankle swelling was assessed as a 4-point scale ranging from 0 (no swelling) to 3 (severe swelling) rated by the investigator. The primary efficacy end point was the patient's assessment of ankle pain via NRS and the degree of swelling on day seven. Results Results showed a significant decrease in pain on weight bearing, pain at rest and the extent of swelling (P<0.001) in both groups, but there was no substantial difference between the two groups (P>0.05) after seven days. Assessing the safety profile of the two different dosing, 13.3% of the naproxen BID group and 6.7% of the as needed group had adverse events, showing that the as needed regimen was safer (P<0.001). Conclusion Results showed that naproxen as needed may reduce the pain and edema of the sprained ankle with no significant difference compared to the BID regimen, while it possesses better safety profile and lower total drug use.
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Affiliation(s)
- Majid Hajimaghsoudi
- Emergency Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Jalili
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Address: Emergency Medicine Department, Imam Khomini Hospital, Keshavarz Blvd, Tehran, Iran.
| | - Mehdi Mokhtari
- Department of Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Nejati
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Mesbahi
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Koosha Paydary
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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Lewiss RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Duprey K, Stone M, Theodoro D, Akhtar S. CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med 2013; 20:740-5. [PMID: 23859589 DOI: 10.1111/acem.12164] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 03/23/2013] [Accepted: 03/24/2013] [Indexed: 01/01/2023]
Abstract
In 2012, the Accreditation Council for Graduate Medical Education (ACGME) designated ultrasound (US) as one of 23 milestone competencies for emergency medicine (EM) residency graduates. With increasing scrutiny of medical educational programs and their effect on patient safety and health care delivery, it is imperative to ensure that US training and competency assessment is standardized. In 2011, a multiorganizational committee composed of representatives from the Council of Emergency Medicine Residency Directors (CORD), the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine (SAEM), the Ultrasound Section of the American College of Emergency Physicians (ACEM), and the Emergency Medicine Residents' Association was formed to suggest standards for resident emergency ultrasound (EUS) competency assessment and to write a document that addresses the ACGME milestones. This article contains a historical perspective on resident training in EUS and a table of core skills deemed to be a minimum standard for the graduating EM resident. A survey summary of focused EUS education in EM residencies is described, as well as a suggestion for structuring education in residency. Finally, adjuncts to a quantitative measurement of resident competency for EUS are offered.
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Affiliation(s)
- Resa E. Lewiss
- Department of Emergency Medicine; St. Luke's Roosevelt Hospital Center; New York; NY
| | - Michelle Pearl
- Department of Emergency Medicine; Cedars-Sinai Medical Center; Los Angeles; CA
| | - Jason T. Nomura
- Department of Emergency Medicine; Christiana Care Health System; Newark; DE
| | - Gillian Baty
- Department of Emergency Medicine; University of New Mexico; Albuquerque; NM
| | - Rimon Bengiamin
- Department of Emergency Medicine; University of California San Francisco at Fresno; Fresno; CA
| | - Kael Duprey
- Long Island Jewish Medical Center; New Hyde Park; NY
| | - Michael Stone
- Department of Emergency Medicine; Brigham & Women's Hospital; Boston; MA
| | - Daniel Theodoro
- Department of Emergency Medicine; Washington University Hospital Center; St. Louis; MO
| | - Saadia Akhtar
- Department of Emergency Medicine; Beth Israel Hospital Center; New York; NY
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Beeson MS, Carter WA, Christopher TA, Heidt JW, Jones JH, Meyer LE, Promes SB, Rodgers KG, Shayne PH, Swing SR, Wagner MJ. The development of the emergency medicine milestones. Acad Emerg Med 2013; 20:724-9. [PMID: 23782404 DOI: 10.1111/acem.12157] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/22/2013] [Accepted: 03/24/2013] [Indexed: 12/01/2022]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014. A key component of the NAS is the development of assessable milestones, which are explicit accomplishments or behaviors that occur during the process of residency education. Milestones describe competencies more specifically and identify specialty-specific knowledge, skills, attitudes, and behaviors (KSABs) that can be used as outcome measures within the general competencies. The ACGME and the American Board of Emergency Medicine (ABEM) convened an EM milestone working group to develop the EM milestones. This article describes the development, use within the NAS, and challenges of the EM milestones.
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Affiliation(s)
- Michael S. Beeson
- Department of Emergency Medicine; Akron General Medical Center; Akron; OH
| | - Wallace A. Carter
- Department of Emergency Medicine; New York Presbyterian Hospital; New York; NY
| | - Theodore A. Christopher
- Department of Emergency Medicine; Thomas Jefferson University and Hospitals; Philadelphia; PA
| | - Jonathan W. Heidt
- Department of Emergency Medicine; Washington University in St. Louis School of Medicine; St. Louis; MO
| | - James H. Jones
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis; IN
| | - Lynne E. Meyer
- Accreditation Council for Graduate Medical Education; Chicago; IL
| | - Susan B. Promes
- Department of Emergency Medicine; University of California San Francisco; San Francisco; CA
| | - Kevin G. Rodgers
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis; IN
| | | | - Susan R. Swing
- Accreditation Council for Graduate Medical Education; Chicago; IL
| | - Mary Jo Wagner
- Department of Emergency Medicine; Central Michigan University Healthcare; Mount Pleasant; MI
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Components of the Model of the Clinical Practice of Emergency Medicine: A Survey of American Board of Emergency Medicine Diplomates. J Emerg Med 2013; 44:1153-66. [DOI: 10.1016/j.jemermed.2012.11.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/24/2012] [Accepted: 11/22/2012] [Indexed: 11/23/2022]
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Wang LM, How CK, Yang MC, Su S, Chern CH. Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan. Emerg Med J 2013; 30:192-7. [PMID: 22433586 PMCID: PMC3582046 DOI: 10.1136/emermed-2011-200910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians' (EPs) subjective reasoning and senior EPs' objective evaluation. DESIGN This was a combined prospective follow-up and retrospective review of cases of consecutive adult non-traumatic patients who presented to a tertiary-care emergency department in Taiwan between 1 September 2005 and 31 July 2006. Data were extracted from 'on-duty EPs' subjective reasoning for discharging patients with CSAEs (study group) and without CSAEs (control group)' and 'objective evaluation of CSAEs by senior EPs, using clinical evidences such as recording history, physical examinations, laboratory/radiological examinations and observation of inadequacies in the basic management process (such as recording history, physical examinations, laboratory/radiological examinations and observation) as the guide'. Subjective reasons for discharging patients' improvement of symptoms, and the certainty of safety of the discharge were compared in the two groups using χ(2) statistics or t test. RESULTS Of the 20,512 discharged cases, there were 1370 return visits (6.7%, 95% CI 6.3% to 7%) and 165 CSAEs due to physicians' factors (0.82%, 95% CI 0.75% to 0.95%). In comparisons between the study group and the control group, only some components of discharge reasoning showed a significant difference (p<0.001). Inadequacies in the basic management process were the main cause of CSAEs (164/165). CONCLUSION The authors recommended that EP follow-up of the basic management processes (including history record, physical examination, laboratory and radiological examinations, clinical symptoms/signs and treatment) using clinical evidence as a guideline should be made mandatory.
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Affiliation(s)
- Lee-Min Wang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan, ROC
- Emergency Medicine, School of Medicine, National Yang-Ming University, Taiwan, ROC
- Institute of Health Care Organization Administration, National Taiwan University, Taiwan, ROC
| | - Chorng-Kuang How
- Emergency Medicine, School of Medicine, National Yang-Ming University, Taiwan, ROC
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Ming-Chin Yang
- Institute of Health Care Organization Administration, National Taiwan University, Taiwan, ROC
| | - Syi Su
- Institute of Health Care Organization Administration, National Taiwan University, Taiwan, ROC
| | - Chii-Hwa Chern
- Emergency Medicine, School of Medicine, National Yang-Ming University, Taiwan, ROC
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan, ROC
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Denny CJ, Steinhart BD, Yu R. Improving physician flow and efficiency in the emergency department. CAN J EMERG MED 2012; 5:271-4. [PMID: 17472772 DOI: 10.1017/s1481803500008496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Backlund BH, Hopkins E, Kendall JL. Ultrasound guidance for central venous access by emergency physicians in colorado. West J Emerg Med 2012; 13:320-5. [PMID: 22942932 PMCID: PMC3421972 DOI: 10.5811/westjem.2011.11.6821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/29/2011] [Accepted: 11/08/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction To survey emergency physicians (EP) regarding the frequency of use of ultrasound guidance for placement of central venous catheters (UGCVC) and to assess their perceptions regarding the technique and barriers to its implementation. Methods A 25-question Web-based survey was e-mailed to all members of the Colorado chapter of the American College of Emergency Physicians with a listed e-mail address. A total of 3 reminders were sent to nonresponders. Results Responses were received from 116 out of 330 invitations. Ninety-seven percent (n = 112) of respondents indicated they have an ultrasound machine available in their emergency department, and 78% indicated they use UGCVC. Seventy-seven percent (n = 90) agreed with the statement, “Ultrasound guidance is the preferred method for central venous catheter placement in the emergency department.” However, 23% of respondents stated they have received no specific training in UGCVC. Twenty-six percent (n = 28) of respondents stated they felt “uncomfortable” or “very uncomfortable” with UGCVC, and 47% cite lack of training in UGCVC as a barrier to performing the technique. Conclusion Although the majority of surveyed EPs feel UGCVC is a valuable technique and do perform it, a significant percentage reported receiving no training in the procedure and also reported being uncomfortable performing it. Nearly half of those surveyed cited lack of training as a barrier to more widespread implementation of UGCVC. This suggests that there continues to be a need for education and training of EPs in UGCVC.
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Wadman MC, Lyons WL, Hoffman LH, Muelleman RL. Assessment of a chief complaint-based curriculum for resident education in geriatric emergency medicine. West J Emerg Med 2012; 12:484-8. [PMID: 22224144 PMCID: PMC3236144 DOI: 10.5811/westjem.2010.10.1722] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 05/07/2010] [Accepted: 10/18/2010] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We hypothesized that a geriatric chief complaint-based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED). METHODS A geriatric chief complaint curriculum addressing the 3 most common chief complaints-abdominal pain, weakness, and falls-was developed and presented. A pre- and postcurriculum implementation chart review assessed resident documentation of the 5 components of geriatric ED care: 1) differential diagnosis/patient evaluation considering atypical presentations, 2) determination of baseline function, 3) chronic care facility/caregiver communication, 4) cognitive assessment, and 5) assessment of polypharmacy. A single reviewer assessed 5 pre- and 5 postimplementation charts for each of 18 residents included in the study. We calculated 95% confidence and determined that statistical significance was determined by a 2-tailed z test for 2 proportions, with statistical significance at 0.003 by Bonferroni correction. RESULTS For falls, resident documentation improved significantly for 1 of 5 measures. For abdominal pain, 2 of 5 components improved. For weakness, 3 of 5 components improved. CONCLUSION A geriatric chief complaint-based curriculum improved emergency medicine resident documentation for the care of elderly patients in the ED compared with a non-age-specific chief complaint-based curriculum.
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Affiliation(s)
- Michael C Wadman
- University of Nebraska Medical Center, Department of Emergency Medicine, Omaha, Nebraska
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Weingart GS, Carlson JN, Callaway CW, Frank R, Wang HE. Estimates of sedation in patients undergoing endotracheal intubation in US EDs. Am J Emerg Med 2012; 31:222-6. [PMID: 22770915 DOI: 10.1016/j.ajem.2012.05.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 04/23/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Sedations after endotracheal intubation (ETI) reduce the risk of self-extubation, uncontrolled pain, and myocardial infarction. Although several small single-center studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED), little is known regarding post-ETI sedative drug practices nationally. METHODS We performed a retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009. We identified all ED patient visits with ETI. Using the multiple probability sampling design of the National Hospital Ambulatory Medical Care Survey, we estimated the proportion of ETI patients receiving pharmacologic sedation, defined as benzodiazepines, opiates, or other sedative agents (propofol, ketamine, etc). We compared patients receiving sedative drugs with those who did not using descriptive statistics and univariable logistic regression. RESULTS During the 4-year study period, 1071000 patients (95% confidence interval [CI], 839000-1303000) underwent ETI in the ED. Of intubated patients, 46.4% (95% CI, 40.2%-52.7%) received sedative drugs, most commonly benzodiazepines (67.9%). Of patients who survived to hospital admission, 57.4% (95% CI, 48.7%-65.7%) received sedative drugs. Patients were less likely to receive sedation if they were diagnosed with circulatory or cardiac disease (odds ratio, 0.51; P = .026). Use of sedative drugs was not associated with patient age, sex, race, geographic location, or extended ED length of stay (>2 hours). CONCLUSION Less than one-half of patients undergoing ETI in the ED receive sedative drugs while in the ED. These findings are congruent with prior smaller studies from single academic centers.
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Affiliation(s)
- Gregory S Weingart
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Perina DG, Brunett CP, Caro DA, Char DM, Chisholm CD, Counselman FL, Heidt J, Keim SM, Ma OJ. The 2011 model of the clinical practice of emergency medicine. Acad Emerg Med 2012; 19:e19-40. [PMID: 22651693 DOI: 10.1111/j.1553-2712.2012.01385.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The 2011 Model of the Clinical Practice of Emergency Medicine.
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