National growth in simulation training within emergency medicine residency programs, 2003-2008

Impact of visual distraction on neonatal mask ventilation: a simulation-based eye-tracking study

OBJECTIVE

This study aimed to investigate whether distractions during simulated neonatal resuscitation impact mask leakage and visual gaze patterns during positive pressure ventilation (PPV) of a newborn manikin.

STUDY DESIGN

In this observational, simulation-based study, medical students and paediatric residents managed a neonate requiring resuscitation alongside a standardised team and executed PPV on a leak-free manikin. The scenario incorporated distractions such as chest compressions, preparation and insertion of an umbilical vein catheter, administering fluids and interpreting venous blood gas. Ventilation parameters were monitored using a respiratory function monitor, and participants were equipped with eye-tracking glasses to assess visual gaze patterns. Additionally, they self-assessed their level of distractions and estimated performance. Measures included dwell time, mask leak, minute volume and respiratory rate to determine whether PPV parameters and distractors were associated during times of interest (TOI).

RESULTS

We included 30 participants and observed statistically significant differences in the delivery of PPV parameters between TOIs with distractions compared with TOIs without distractions, as reflected in mask leak (31.0 vs 15.9 %), minute volume (202.0 vs 253.0 mL/kg/min) and respiratory rate (29.0 vs 33.0/min). Results on alterations in gaze behaviour showed a significant gaze shift from the infant's chest and airway to instruments and other areas of interest when distractions were present. During the venous blood gas interpretation, participants rated their performance worse than during other TOIs. Participants generally overrated their ventilation quality.

CONCLUSION

This study showed a significant impact of distractions on PPV parameters and visual attention during simulated neonatal resuscitation.

Evaluate the knowledge, attitudes, and practices of emergency medicine physicians in managing priapism cases-a cross section study

Introduction

Priapism is an emergency condition treated by emergency medicine (EM) physicians and urologists/andrologists. EM physicians are the first-line healthcare providers for this condition, and their knowledge, attitudes, and practices regarding priapism remain unclear.

Aim

The aim of this study was to understand emergency physicians' perspectives regarding priapism to help re-structure EM programs.

Methods

This cross-sectional study on knowledge, attitude, and practice (KAP) surveyed emergency physicians from a university and other hospitals in the Ismailia governorate, Egypt. A validated questionnaire was sent via an online e-survey following the CHEERIES guidelines. Bivariate analysis of demographic characteristics and KAP was performed using by odds ratios and 95% confidence intervals. Spearman's rho was used to measure the correlation between knowledge, attitude, and practice. A P <0.05 was considered statistically significant.

Main Outcome Measure

Emergency physicians completed an e-survey of their knowledge, attitudes, and practices regarding priapism.

Results

A total of 149 participants were surveyed. 140 (93%) of EM physicians believed priapism was a medical emergency. 139 (93%) respondents were aware of the long-term complications of priapism. Further, 136 (91.3%) respondents strongly supported the multidisciplinary approach. Of these, 79 (53%) gave intra-cavernous sympathomimetic therapy and 75 (50.3%) did aspiration with irrigation. EM physicians <30 years of age had significantly better knowledge about priapism (OR = 2.47 (1.23-4.96); P = 0.01). Similarly, young physicians had better attitudes (OR = 3.24 (1.31-8.02); P = 0.01) and female physicians demonstrated better practice (OR = 3.36 (1.65-6.82); P = 0.001) toward priapism. A significant positive correlation was observed between knowledge and attitude (r = 0.487), and knowledge and practice (r = 0.281) at P <0.001.

Clinical Implications

EM physicians agreed that EM-based therapy is appropriate for straightforward cases of acute ischemic priapism. Existing educational programs for EM physicians may not adequately equip them in handling priapism in practice.

Strengths and Limitations

This study is the first to investigate EM knowledge, attitude, and practice (KAP) for priapism handling. The study identified areas for improvement in this regard. However, the cross-sectional design, single governorate setting, and self-administered questionnaire limit its generalizability.

Conclusion

Despite the satisfactory knowledge and attitudes of EM physicians regarding priapism and infection control, this study identified potential areas for improvement in the use of guidelines on invasive treatment.

Designing simulation-based curriculum content for emergency medicine residents in France: a Delphi method

BACKGROUND

The value of simulation in emergency medicine is indisputable because it allows training and acquisition of many technical and non-technical skills (TS and NTS). In France, there are no curriculum regarding the use of simulation as a teaching tool during emergency medicine residency. The aim of this study was to design the content of a national simulation-based curriculum for emergency medicine residency programs.

METHODS

The Delphi method was conducted between March and June 2022. The questionnaire was divided into three sections: TS, NTS and clinical situations as starting points (SSPs). A panel of emergency physicians' experts on simulation education was established. An online survey was conducted in which they were asked to score, on a four-point Likert scale, the suitability of skills and SSPs to be taught through simulation courses during the emergency medicine residency. The questionnaire was revised between each round following comments or suggestions for additional items from the experts.

RESULTS

Sixty-six experts completed the Delphi process. The initial questionnaire included 64 TS, 37 NTS and 103 SSPs. The experts' comments led to the addition of 12 TS, 24 NTS and 6 SSPs. Consensus was obtained after three rounds. The experts selected 24 TS and 20 NTS to be taught as a priority through simulation during the emergency medicine residency, and 15 SSPs to be used in priority.

CONCLUSION

With a Delphi method, French experts in simulation-based emergency medicine education have selected 24 technical and 20 non-technical skills to be taught as a priority with simulation-based training to emergency medicine residents.

Competence over confidence: uncovering lower self-efficacy for women residents during central venous catheterization training

BACKGROUND

While women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance.

METHODS

173 surgical residents (Nwomen=61, Nmen=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women.

RESULTS

General estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p < .0035). Mann-Whitney U and Fisher's exact tests showed there were no performance differences between men and women for successfully accessing the vein on the DHRT. Regression models relating performance and self-efficacy found no correlation for either gender.

CONCLUSIONS

These results indicate that despite receiving the same SBT and performing at the same level, the gender-confidence gap exists in CVC SBT, and the Dunning-Kruger effect may also be evident.

LGBTQ+ individuals are not explicitly represented in emergency medicine simulation curricula

Background

Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior.

Methods

We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher's Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior.

Results

Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior.

Conclusions

LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Near-peer teaching in simulation

BACKGROUND

Development, implementation and evaluation of a simulation curriculum is time and resource intensive. Limited faculty time and training are cited as primary barriers to adopting simulation into medical education. Near-peer teaching is a potential solution to manage the increased teaching demands that occur with simulation use.

APPROACH

In 2022, we implemented a near-peer simulation curriculum for teaching junior physical medicine and rehabilitation (PM&R) residents high-acuity low-opportunity events commonly seen on the inpatient rehabilitation unit. The curriculum was taught by senior residents to supplement faculty lectures. Senior residents completed facilitator training on simulator logistics, debriefing and formative assessment.

EVALUATION

Residents completed an end-of-course questionnaire evaluating teaching effectiveness and perceived knowledge acquisition. All items were scored on a 5-point Likert-type scale. Learners rated their near-peers as having good clinical teaching effectiveness (mean [SD], 4.66[0.38]). Senior residents (n = 6) disclosed feeling knowledgeable about the topics they instructed (baseline 3.9[3.2-4.4]; after 4.6[4.1-4.9]; p = 0.19), and junior residents (n = 6) felt they gained knowledge and improved their ability to manage patients as a result of the near-peer curriculum (baseline 2.4[2.3-2.5]; after 3.9[3.5-4.2]; p = 0.005).

IMPLICATIONS

This educational programme is an example of how near-peer teaching can be used in simulation. Our simulation curriculum taught by near-peers was valued by learners as well taught and educational. Research is needed that directly compares the effectiveness of near-pear teaching to faculty instruction. We hope that by sharing our work, educators will feel inspired to use near-peer teachers for simulation instruction when faculty availability for teaching is scarce.

Workshop in Simulation Debriefing for Educators in Medicine: Creation, implementation, and evaluation of a debriefing curriculum for novice simulation educators

Objectives

Debriefing is an integral component of simulation education, and effective debriefing education is required to maintain effective simulation programs. However, many educators report financial and logistical barriers to accessing formal debriefing training. Due to limited educator development opportunities, simulation program leaders are often compelled to utilize educators with insufficient debriefing training, which can limit the impact of simulation-based education. To address these concerns, the SAEM Simulation Academy Debriefing Workgroup authored the Workshop in Simulation Debriefing for Educators in Medicine (WiSDEM), a freely available, concise, and ready-to-deploy debriefing curriculum with a target audience of novice educators without formal debriefing training. In this study, we describe the development, initial implementation, and evaluation of the WiSDEM curriculum.

Methods

The Debriefing Workgroup iteratively developed the WiSDEM curriculum by expert consensus. The targeted level of content expertise was introductory. The curriculum's educational impact was assessed by surveying participants on their impressions of the curriculum and their confidence and self-efficacy in mastery of the material. Additionally, facilitators of the WiSDEM curriculum were surveyed on its content, usefulness, and future applicability.

Results

The WiSDEM curriculum was deployed during the SAEM 2022 Annual Meeting as a didactic presentation. Thirty-nine of 44 participants completed the participant survey, and four of four facilitators completed the facilitator survey. Participant and facilitator feedback on the curriculum content was positive. Additionally, participants agreed that the WiSDEM curriculum improved their confidence and self-efficacy in future debriefing. All surveyed facilitators agreed that they would recommend the curriculum to others.

Conclusions

The WiSDEM curriculum was effective at introducing basic debriefing principles to novice educators without formal debriefing training. Facilitators felt that the educational materials would be useful for providing debriefing training at other institutions. Consensus-driven, ready-to-deploy debriefing training materials such as the WiSDEM curriculum can address common barriers to developing basic debriefing proficiency in educators.

Technology-enhanced simulation in emergency medicine: Updated systematic review and meta-analysis 1991-2021

Background

Over the past decade, the use of technology-enhanced simulation in emergency medicine (EM) education has grown, yet we still lack a clear understanding of its effectiveness. This systematic review aims to identify and synthesize studies evaluating the comparative effectiveness of technology-enhanced simulation in EM.

Methods

We searched MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Web of Science, and Scopus to identify EM simulation research that compares technology-enhanced simulation with other instructional modalities. Two reviewers screened articles for inclusion and abstracted information on learners, clinical topics, instructional design features, outcomes, cost, and study quality. Standardized mean difference (SMD) effect sizes were pooled using random effects.

Results

We identified 60 studies, enrolling at least 5279 learners. Of these, 23 compared technology-enhanced simulation with another instructional modality (e.g., living humans, lecture, small group), and 37 compared two forms of technology-enhanced simulation. Compared to lecture or small groups, we found simulation to have nonsignificant differences for time skills (SMD 0.33, 95% confidence interval [CI] -0.23 to 0.89, n = 3), but a large, significant effect for non-time skills (SMD 0.82, 95% CI 0.18 to 1.46, n = 8). Comparison of alternative types of technology-enhanced simulation found favorable associations with skills acquisition, of moderate magnitude, for computer-assisted guidance (compared to no computer-assisted guidance), for time skills (SMD 0.50, 95% CI -1.66 to 2.65, n = 2) and non-time skills (SMD 0.57, 95% CI 0.33 to 0.80, n = 6), and for more task repetitions (time skills SMD 1.01, 95% CI 0.16 to 1.86, n = 2) and active participation (compared to observation) for time skills (SMD 0.85, 95% CI 0.25 to 1.45, n = 2) and non-time skills (SMD 0.33 95% CI 0.08 to 0.58, n = 3).

Conclusions

Technology-enhanced simulation is effective for EM learners for skills acquisition. Features such as computer-assisted guidance, repetition, and active learning are associated with greater effectiveness.

The Reliability of the Resuscitation Assessment Tool (RAT) in Assessing Emergency Medicine Resident Competence in Pediatric Resuscitation Scenarios: A Prospective Observational Pilot Study

Introduction Emergency medicine (EM) postgraduate medical education in Canada has transitioned from traditional time-based training to competency-based medical education (CBME). In order to promote residents through stages of training, simulated assessments are needed to evaluate residents in high-stakes but low-frequency medical emergencies. There remains a gap in the literature pertaining to the use of evaluative tools in simulation, such as the Resuscitation Assessment Tool (RAT) in the new CBME curriculum design. Methods We completed a pilot study of resident physicians in one Canadian EM training program to evaluate the effectiveness and reliability of a simulation-based RAT for pediatric resuscitation. We recorded 10 EM trainees completing simulated scenarios and had nine EM physicians use the RAT tool to evaluate their performances. Generalizability theory was used to evaluate the reliability of the RAT tool. Results The mean RAT score for the management of pediatric myocarditis, cardiac arrest, and septic shock (appendicitis) across raters was 3.70, 3.73, and 4.50, respectively. The overall generalizability coefficient for testing simulated pediatric performance competency was 0.77 for internal consistency and 0.75 for absolute agreement. The performance of senior participants was superior to that of junior participants in the management of pediatric myocarditis (p = 0.01) but not statistically significant in the management of pediatric septic shock (p=0.77) or cardiac arrest (p =0.61). Conclusion Overall, our findings suggest that with an appropriately chosen simulated scenario, the RAT tool can be used effectively for the simulation of high-stakes and low-frequency scenarios for practice to enhance the new CBME curriculum in emergency medicine training programs.

Introducing the "SIMline"-A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.

Assessment of the July Effect on Bronchoscopies in Teaching Hospitals Across the United States

BACKGROUND

The July effect is the perceived notion that at the start of each academic year there is an increase in medical complications as the novice physician begins their new respective roles. Our study evaluated complication rates in the beginning versus end of the academic year with regards to bronchoscopy.

METHODS

This is a retrospective cohort study using the 2016 and 2017 Nationwide Inpatient Sample. Patients in the database that underwent bronchoscopy at teaching hospitals were determined using ICD-10 procedure codes. Our outcomes included length of hospital stay and several bronchoscope complications. We compared our outcomes in the first quarter of the academic year (July, August, and September) to the last quarter (April, May, and June). Multivariable logistic and linear regression analysis were used accordingly to adjust for confounders.

RESULTS

There was a total of 189,720 admission for bronchoscopy. Of these hospitalization 89,020 bronchoscopies were done in first academic Quarter (Q1) while 100,700 bronchoscopies were done in fourth academic Quarter (Q4) in 2016 to 2017 academic year. After adjusting for confounders, there was no difference in any postprocedural complications between Q1 and Q4 or length of stay.

CONCLUSION

Within the limitation of the national data set provided, there appears to be similar procedural complication rates for patients admitted Q1 compared with Q4 of the academic year in respect to bronchoscopy, signaling the possibility of lack of the July effect. Prospective studies with improved data granularity is needed to further verify the absence or presence of the July effect regarding bronchoscopy.

Aile Hekimliği Uzmanlık Eğitiminde Simülasyon Temelli Eğitim Yaklaşımlarının Değerlendirilmesi

Amaç: Etkinliğimizin amacı TUKMOS (Tıpta Uzmanlık Kurulu Müfredat Oluşturma ve Standart Belirleme Sistemi) Aile Hekimliği uzmanlık eğitimi müfredatında yer alan girişimsel yetkinlikleri simülasyon merkezimizdeki imkanlar kullanılarak Aile Hekimliği Asistanlarına sunularak beceri düzeylerinin arttırılmasıdır. Gereç ve Yöntem: TÜBİTAK-BİDEP 2237 Destekleme Programı doğrultusunda planladığımız ‘RSİM 1. Aile Hekimliği Asistanları Simülayon Eğitimi’ projesini toplam 32 Aile Hekimi asistanın katılımıyla gerçekleştirdik. Tüm katılımcılara eğitim ön test-son test uygulandı. Ayrıca 34 sorudan oluşan simülasyon eğitimi geri bildirim anketi yapılmıştır. Bulgular: Eğitime katılanların %71,9’u(n:23) kadın, %56,2’si(n:18) üniversite hastanesinde çalışmaktaydı. Hekimlikte geçen aktif çalışma süresi 2 yıldan az olanlar %59,4 (n:19), asistanlık eğitim süresi 2-3 yıl olanlar %53,1 (n:17) idi. Katılımcıların ön test ve son test ortalama puanları karşılaştırıldığında arasındaki fark istatistiksel olarak anlamlı bulundu(p

Exploring health service preparation for the COVID-19 crisis utilizing simulation-based activities in a Norwegian hospital: a qualitative case study

Introduction

The first wave of the COVID-19 pandemic caused stress in healthcare organizations worldwide. Hospitals and healthcare institutions had to reorganize their services to meet the demands of the crisis. In this case study, we focus on the role of simulation as part of the pandemic preparations in a large hospital in Norway. The aim of this study is to explore hospital leaders' and simulation facilitators' expectations of, and experiences of utilizing simulation-based activities in the preparations for the COVID-19 pandemic.

Methods

This is a qualitative case study utilizing semi-structured in-depth interviews with hospital leaders and simulation facilitators in one large hospital in Norway. The data were sorted under three predefined research topics and further analyzed by inductive, thematic analysis according to Braun and Clarke within these pre-defined topics.

Results

Eleven members of the hospital leadership and simulation facilitators were included in the study. We identified four themes explaining why COVID-19 related simulation-based activities were initiated, and perceived consequences of the activities; 1) a multifaceted method like simulation fitted a multifaceted crisis, 2) a well-established culture for simulation in the hospital was crucial for scaling up simulation-based activities during the crisis, 3) potential risks were outweighed by the advantages of utilizing simulation-based activities, and finally 4) hospital leaders and simulation facilitators retrospectively assessed the use of simulation-based activities as appropriate to prepare for a pandemic crisis.

Conclusions

The hospital leadership’s decision to utilize simulation-based activities in preparing for the COVID-19 crisis may be explained by many factors. First, it seems that many years of experience with systematic use of simulation-based activities within the hospital can explain the trust in simulation as a valuable tool that were easy to reach. Second, both hospital leaders and simulation facilitators saw simulation as a unique tool for the optimization of the COVID-19 response due to the wide applicability of the method. According to hospital leaders and simulation facilitators, simulation-based activities revealed critical gaps in training and competence levels, treatment protocols, patient logistics, and environmental shortcomings that were acted upon, suggesting that institutional learning took place.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07826-5.

Anxiety and Performance in Prehospital Emergency Care Simulation Assessments

INTRODUCTION

Anxiety experienced by students participating in simulations may impede their learning and performance. The added anxiety brought about by the socioevaluative nature of simulation assessments may accentuate this effect. This study aimed to assess the relationship between anxiety experienced by emergency care students and performance in an authentic prehospital emergency care simulation assessment.

METHODS

The State-Trait Anxiety Inventory (STAI) was completed before and after a simulation assessment by 58 emergency care students across all academic years of study of a 4-year degree program in prehospital emergency care. The state anxiety component of the STAI was plotted together with marks obtained by each student using a standardized assessment tool, and curve estimation was used to determine the nature of the relationship between state anxiety scores and marks.

RESULTS

Mean preassessment STAI scores were lower than mean postassessment scores (48.74 vs. 57.74), but mean scores from both groups were greater than normal mean scores for college students. The relationship of both preassessment and postassessment STAI scores with assessment marks was best described by a quadratic curve suggesting that performance was better at both the lower and higher ends of the range of STAI scores compared with the middle. Postassessment STAI scores provided a better fit with simulation assessment marks.

CONCLUSIONS

This study did not confirm the expected decrease in performance associated with increasing anxiety but rather suggests that some students may have the ability to respond positively to the highest levels of anxiety during simulation assessments.

A Simulated Scenario to Improve Resident Efficiency in an Emergency Department

Introduction

Multitasking is a core competency in emergency medicine. Simulation has been shown to be an effective method of education, which allows learners to prepare for real-world challenges in a controlled environment.

Methods

In this study, trainees were given a scenario that simulated the experience of managing two patient encounters within a time metric while addressing interruptions that take place in a typical ED. Residents were evaluated using an internally developed scoresheet, which assessed task-switching abilities, documentation skills, and adherence to door to disposition time metric. Residents were asked to evaluate their experience with a survey.

Results

All the participants reported that they would translate some of the skills learned to their daily clinical practice. Five out of six residents reported improvements in their skills as a result of the task-switching training. The following three common themes were pervasive in the debrief discussion: (1) the residents felt the added pressure of the door-to-disposition metric, (2) the objectives of the simulation did not fit within their pre-constructed concept of a successful simulation equating to establishing the correct diagnosis, and (3) the interruptions were very realistic.

Discussion

Emergency physicians are interrupted approximately every 9-14 minutes, and this number increases with the number of patients being managed simultaneously. By developing a safe, simulated training environment, we sought to transfer key strategies for improving focus and learning to prioritize while also helping them to identify how certain pressures and interruptions affected their stress levels and concentration.

Taking the Pulse on Pediatric Simulation: A National Survey of Pediatric Residency Programs' Simulation Practices and Challenges

OBJECTIVES

There is abundant literature on simulation use in individual pediatric residency programs but limited overall data on simulation in US pediatric residency programs. This study sought to determine how US pediatric residency programs use simulation for teaching and assessment and the challenges programs face in their use of simulation.

METHODS

The Association of Pediatric Program Director's Healthcare Simulation in Pediatrics Learning Community members developed a 15-multipart question survey on the use of simulation in US pediatric residency programs using best practices in survey design. The survey was distributed electronically to US pediatric residency program directors. Qualitative questions were analyzed by content analysis and quantitative questions using descriptive statistics.

RESULTS

The survey response rate was 21%; respondents were disproportionately from large academic medical centers. Qualitative analysis found that respondents use simulation to teach pediatric residents in the areas of urgent/emergent situations, procedures, and communication, and common challenges to simulation implementation are time, physical resources, expertise, competing priorities, logistics, and buy-in. Quantitative analysis demonstrated that, although respondents are largely confident that their simulation programs improve resident preparedness and competence, few objectively evaluate their simulation programs.

CONCLUSIONS

Pediatric residency programs use simulation for similar purposes and face similar challenges. By collaborating, the resources of the national pediatric simulation community can be leveraged to collect evidence for best practices for simulation use in pediatric residency training.

Credentialing Pediatric Emergency Medicine Faculty in Point-of-Care Ultrasound: Expert Guidelines

ABSTRACT

As point-of-care ultrasound (POCUS) becomes standard practice in pediatric emergency medicine (PEM), it is important to have benchmarks in place for credentialing PEM faculty in POCUS. Faculty must be systematically trained and assessed for competency in order to be credentialed in POCUS and granted privileges by an individual institution. Recommendations on credentialing PEM faculty are needed to ensure appropriate, consistent, and responsible use of this diagnostic and procedural tool. It is our intention that these guidelines will serve as a framework for credentialing faculty in PEM POCUS.

Three-dimensional simulator: training for beginners in endovascular embolization with liquid agents

BACKGROUND

To design a simulator for novices without prior experience in embolization with liquid agents such as n-Butyl cyanoacrylate (n-BCA) and to evaluate the simulator using surveys and post hoc video analysis.

MATERIALS AND METHODS

The simulator was created using computer-aided design software and three-dimensionally printed. Before an embolization, trainees completed questionnaires regarding their level of expertise and self-reported confidence level. The participants were shown an instruction video and each participant performed four embolizations on the simulator. Subsequently, the participants completed surveys on self-reported confidence level and assessed the simulator's face and content validity.

RESULTS

Five experts and twelve novices trained on the simulator. The experts were radiology residents and fellows with at least 5 years of work experience in interventional radiology. The novices were medical students and radiology residents without any previous experience with embolization. Based on the surveys, the experts assessed the simulator as very useful for embolization training. Performance, e.g. mean duration embolization between experts (mean ± standard deviation = 189 ± 42 s) and novices (mean ± standard deviation = 235 ± 66 s) were significantly different (p = .001). The overall simulation of the embolization process, simulated complications, and educational capabilities of the simulator were evaluated positively. In the novice group the self-reported confidence level significantly increased (p = .001).

CONCLUSION

The liquid embolization simulator proposed here is a suitable educational tool for training embolization procedures. It reduces the duration of embolization procedures and improves the confidence level of beginners in embolization.

The use of a formative OSCE to prepare emergency medicine residents for summative OSCEs: a mixed-methods cohort study

Background

The objective structured clinical examination (OSCE) is a part of emergency medicine (EM) examinations such as the Masters of Medicine in Emergency Medicine (MMed) examination and the equivalent Member of the Royal College of Emergency Medicine (MRCEM) examination. The use of formative OSCEs to prepare EM residents for summative OSCEs has not been investigated. This study aimed to evaluate the role of formative OSCEs in preparing EM residents for the MMed and MRCEM OSCE.

Methods

This was an observational, retrospective, mixed-methods cohort study. We analysed data from formative OSCEs conducted by the National Healthcare Group EM residency programme from 2013 to 2019, and from a questionnaire distributed to all residents during the study period. Residents’ formative OSCE participation and scores were compared with first-attempt summative OSCE success. Qualitative analysis of residents’ opinions on the usefulness of the formative OSCE was performed.

Results

Forty-three of the 50 (86.0%) residents attended at least one formative OSCE. Of the 46 who responded to the questionnaire, 40 (87.0%) had attempted and succeeded in the MMed or MRCEM OSCE, of whom 35 (87.5%) had succeeded on the first attempt. Residents who succeeded in the summative OSCE on the first attempt tended to have higher proximate (mean = 70.6, SD = 8.9 vs mean = 64.3, SD = 10.8) and mean (mean = 67.4, SD = 7.1 vs mean = 62.8, SD = 7.3) formative OSCE scores. All 8/40 (20.0%) residents who attended more than three formative OSCEs succeeded in the summative OSCE on their first attempt. Residents’ formative OSCE scores tended to improve with successive formative OSCEs, demonstrating a positive training effect. All residents felt that the formative OSCE was useful in preparing them for the summative OSCE.

Conclusions

Participation in multiple formative OSCEs was beneficial in preparing residents for the summative OSCE. The formative OSCE was useful in familiarising residents with the examination, giving them an opportunity to perform in near-examination conditions, and providing feedback to residents and faculty about their progress. Our findings may support the implementation of formative OSCEs in other training programmes to prepare learners for high-stake summative OSCEs.

How do they learn: types and characteristics of medical and healthcare student engagement in a simulation-based learning environment

BACKGROUND

Student engagement can predict successful learning outcomes and academic development. The expansion of simulation-based medical and healthcare education creates challenges for educators, as they must help students engage in a simulation-based learning environment. This research provides a reference for facilitators of simulation teaching and student learning in medical and health-related majors by providing a deep understanding of student engagement in a simulation-based learning environment.

METHODS

We conducted semi-structured interviews with ten medical and healthcare students to explore their learning types and characteristics in a simulation-based learning environment. Thematic analysis was used to analyse the data.

RESULTS

The interviews were thematically analysed to identify three types of student engagement in the simulation-based learning environment: reflective engagement, performance engagement, and interactive engagement. The analysis also identified eight sub-themes: active, persistent, and focused thinking engagement; self-directed-learning thinking engagement with the purpose of problem solving; active "voice" in class; strong emotional experience and disclosure; demonstration of professional leadership; interaction with realistic learning situations; support from teammates; and collegial facilitator-student interaction.

CONCLUSIONS

The student interview and thematic analysis methods can be used to study the richness of student engagement in simulation-based learning environments. This study finds that student engagement in a simulation-based learning environment is different from that in a traditional environment, as it places greater emphasis on performance engagement, which combines both thinking and physical engagement, as well as on interactive engagement as generated through interpersonal interactions. Therefore, we suggest expanding the learning space centring around "inquiry", as it can help strengthen reflective communication and dialogue. It also facilitates imagination, stimulates empathy, and builds an interprofessional learning community. In this way, medical and healthcare students can learn through the two-way transmission of information and cultivate and reshape interpersonal relationships to improve engagement in a simulation-based learning environment.

Heat stroke: knowledge and practices of medical professionals in pediatric emergency medicine departments - a survey study

Background and importance

Heat stroke is a life-threatening condition affecting children worldwide. Rapid cooling remains the most important feature of emergency management. The accepted preferred method of evaporative cooling in the ED as listed by the reference text book endorsed by the Israeli Society of Pediatric Emergency Medicine (PEMI), is actively cooling the patient by spraying him with water and positioning fans to blow air across the body.

Objective

This study aimed to assess Israeli health care workers (HCWs) medical professionals’ knowledge and preparedness of treating heat stroke and recommend policy changes to ensure better treatment based on survey results.

Design, settings and participants

A cross-sectional survey of all HCWs working in an ED that accepts children was conducted. An online questionnaire was utilized to assess heat stroke management practices and available resources in all Israeli pediatric emergency departments (PEDs).

Main results

Data from 208 health care workers was analyzed. Only 30% of the participants reported ever treating a patient with exertional heat stroke. Two scenarios were presented to the participants: motor vehicle-related child hyperthermia (MVRCH) in an infant and an adolescent with exertional heat stroke. One hundred twenty-five (60%) and 83 (40%) participants, respectively, listed cool water with a fan as the primary mode of cooling, which is considered the appropriate preferred method of evaporative cooling in the PED. Certificated pediatric emergency medicine (PEM) physicians answered significantly more correctly regarding both scenarios’ management (P < 0.001). Participants who were trained via simulation in the past, answered significantly more correctly regarding the exertional heat stroke scenario (P < 0.01), however no difference was found regarding the MVRCH case.

Conclusions: The present study exposes weaknesses in HCW knowledge, PED resources, and published PED policies for appropriate management of children following heat stroke. Our finding emphasizes the importance of both certificated PEM physicians attendance and simulation performance for implementing proper management of patients with heat stroke. A policy change should be performed among the Israeli PED community, with respect to establishing and implementing guidelines for treatment of exertional heat stroke. A future study, following an interventional simulation program is planned to be performed.

Development of postgraduate training in critical care medicine for nurse practitioners and physician assistants

ABSTRACT

Nurse practitioners (NPs) and physician assistants (PA) are increasingly providing care to the critically ill patients in the intensive care unit. We structured a 4-month training program for our existing NPs and PAs and assessed their knowledge and skill pre and post training. The program was composed of blended didactic in critical care medicine topics, critical care simulations in simulation laboratory, and supervised critical care procedures. Formal knowledge and skill assessments were performed before and after the program to assess success in meeting predefined learning objectives. The mean preintervention medical knowledge assessment score was 3.37 ± 0.56 SD, which significantly improved to 3.86 ± 0.46 SD (p < .00001). For clinical skills for critical care procedures, the mean preintervention score was 3.10 ± 0.86 SD, which improved to 3.61 ± 0.92 SD (p < .00001). The overall knowledge (including medical knowledge and clinical skills) improved from mean 3.30 ± 0.86 SD to 3.80 ± 0.42 SD. The improvement was seen regardless of the duration of experience in critical care medicine. We concluded that structured didactics with supervised procedural training along with dedicated training in simulation laboratories, even for a short period, improves the overall knowledge and clinical skills required to work in a critical care setting.

Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature

BACKGROUND

The use of simulation-based team training has increased over the past decades. Simulation-based team training within emergency medicine and critical care contexts is best known for its use by trauma teams and teams involved in cardiac arrest. In the domain of emergency medicine, simulation-based team training is also used for other typical time-critical clinical presentations. We aimed to review the existing literature and current state of evidence pertaining to non-technical skills obtained via simulation-based team training in emergency medicine and critical care contexts, excluding trauma and cardiac arrest contexts.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Before the initiation of the study, the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. We conducted a systematic literature search of 10 years of publications, up to December 17, 2019, in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL. Two authors independently reviewed all the studies and extracted data.

RESULTS

Of the 456 studies screened, 29 trials were subjected to full-text review, and 13 studies were included in the final review. None of the studies was randomized controlled trials, and no studies compared simulation training to different modalities of training. Studies were heterogeneous; they applied simulation-training concepts of different durations and intensities and used different outcome measures for non-technical skills. Two studies reached Kirkpatrick level 3. Out of the remaining 11 studies, nine reached Kirkpatrick level 2, and two reached Kirkpatrick level 1.

CONCLUSIONS

The literature on simulation-based team training in emergency medicine is heterogeneous and sparse, but somewhat supports the hypothesis that simulation-based team training is beneficial to teams' knowledge and attitudes toward non-technical skills (Kirkpatrick level 2). Randomized trials are called for to clarify the effect of simulation compared to other modalities of team training. Future research should focus on the transfer of skills and investigate improvements in patient outcomes (Kirkpatrick level 4).

Simulation-based curriculum development: lessons learnt in Global Health education

BACKGROUND

Simulation based medical education (SBME) allows learners to acquire clinical skills without exposing patients to unnecessary risk. This is especially applicable to Emergency Medicine training programs where residents are expected to demonstrate proficiency in the management of time critical, low frequency, and highly-morbidity conditions. This study aims to describe the process through which a SBME curriculum was created, in a limited simulation resource setting at a 4-year Emergency Medicine (EM) residency program at the American University of Beirut Medical Center.

METHODS

A case-based pilot simulation curriculum was developed following Kern's 6 step approach to curriculum design. The curricular objectives were identified through an anonymous survey of the program's residents and faculty. Curriculum outcomes were assessed, and the curriculum was revised to address curricular barriers. Evaluations of the revised curriculum were collected during the simulation sessions and through a whole revised curriculum evaluation at the end of the first year of its implementation.

RESULTS

14/20 residents (70%) and 8/8 faculty (100%) completed the needs assessment from which objectives for the pilot curriculum were developed and implemented through 6 2-h sessions over a 1-year period. Objectives were not met and identified barriers included cost, scheduling, resources, and limited faculty time. The revised curriculum addressed these barriers and 24 40-min sessions were successfully conducted during the following year. The sessions took place 3 at a time, in 2-h slots, using the same scenario to meet the objectives of the different learners' levels. 91/91 evaluations were collected from participants with overall positive results. The main differences between the pilot and the revised curricula included: a better understanding of the simulation center resources and faculty's capabilities.

CONCLUSION

Simulation-based education is feasible even with limited-resources. However, understanding the resources available, and advocating for protected educator time are essential to implementing a successful EM simulation curriculum.

Recommended Musculoskeletal and Sports Medicine Model Curriculum for Emergency Medicine Residency Training

ABSTRACT

Musculoskeletal and sports medicine conditions are common in the emergency department (ED). Emergency physicians may not be receiving adequate education to achieve clinical competency in musculoskeletal medicine during residency training. This article aims to provide a standardized musculoskeletal and sports medicine curriculum for emergency medicine training. Broad curriculum goals include proficiency in evaluating and managing patients presenting to the ED with acute and chronic musculoskeletal complaints and other medical conditions related to or affected by physical exertion, sports participation, or environmental exposure. Specific objectives focus on knowledge of these disorders, physical examination skills, procedural skills including musculoskeletal ultrasound, appropriate consultation and referral, and patient education for these conditions. Educational methods will consist of didactics; online self-directed learning modules; simulation; and supervised clinical experiences in the ED, primary care sports medicine clinics, and orthopedic clinics if available. Curriculum implementation is expected to vary across programs due to differences in residency program structure and resources.

Outcome of Undergraduate Medical Education using Medical Simulation according to Students' Feedback

Objectives

This study aimed to determine students’ overall satisfaction with clinical simulation sessions and compare the satisfaction levels of obstetrics/gynaecology (OBGYN) students (group one) and internal medicine students (group two).

Methods

This study was conducted from January to June 2019 at the Arabian Gulf University, Manama, Bahrain. Students from year five were included and offered sessions that used simulations to support clinical skill development. Data were collected using a five-point Likert scale (i.e. strongly agree, agree, neutral, disagree, strongly disagree) via feedback forms.

Results

A total of 150 students were included in this study (response rate: 99.07%). In groups of seven, the students attended five cycles of simulations with two sessions per cycle in each specialty over six months. The mean percentage of responses of “strongly agree” and “agree” was 97.8 ± 2.3% in group one and 95.7 ± 2.7% in group two. The satisfaction scores of group one were higher than those from group two for all statements. Significant differences were found between groups one and two in their responses to the statement of whether the simulation session was relevant to clinical practice (100% versus 92.9%; P <0.001) and whether the debriefing session was useful (98.1% versus 94.8%; P = 0.015).

Conclusion

Students indicated high satisfaction after attending the simulation sessions; however, OBGYN students were more satisfied compared to those studying internal medicine.

The Impact of Advanced Cardiac Life Support Simulation Training on Medical Student Self-reported Outcomes

Introduction: Simulation has become a well-recognized and innovative tool in medical education. While there has been tremendous growth of simulation curricula at the level of graduate medical education, there have been few studies looking at simulation as a learning tool for undergraduate medical education. The goal of this study was to determine if high-fidelity simulation training impacts medical student perception of knowledge and confidence regarding comprehension and application of advanced cardiac life support (ACLS) algorithms.

Methods: This is a prospective observational survey study of third and fourth year medical students who participated in an ACLS simulation training during their emergency medicine rotation between January 2018 and October 2018. Cases covered several ACLS topics including unstable bradycardia, supraventricular tachycardia and ventricular tachycardia. After each session, students received a short survey to assess their simulation experience pertaining to knowledge and comfort levels with ACLS topics before and after the simulation experience.

Results: A total of 89 students were included in the study with 86.5% of those being fourth year students. There was a significant increase in both knowledge (pre-training 3.17 vs. 4.11 post-training, p<0.001) and comfort scores (pre-training 2.54 vs. 3.74 post-training, p<0.001) after the ACLS simulation training. Overall, 77.5% of students reported an increase in knowledge and 83.1% reported an increase in confidence after the training session. 

Conclusions: The study revealed a statistically significant increase in both perceived knowledge and comfort and confidence of medical students after high-fidelity simulation using ACLS scenarios.

The effect of clinical simulation assessment on stress and anxiety measures in emergency care students

Background

Clinical simulation has become widespread as a training and assessment tool across a range of health professions, including emergency care. As with any form of assessment, simulations may be associated with stress and anxiety (“distress”) which may have a negative effect on student performance if demands required by the simulation outweigh the available resources. This study aimed to assess the effect of participation by students in an emergency care simulation on an objective measure of stress and a subjective measure of anxiety.

Methods

Heart rate variability (HRV) and scores from a validated state anxiety instrument (the State-Trait Anxiety Inventory) were assessed in 36 emergency medical care students participating in scheduled simulation assessments. Data recorded during a resting control period were used for comparison.

Results

HRV variables showed changes in the simulation assessment group suggesting decreased variability and parasympathetic withdrawal, however these were not significantly different to control. Heart rate in the simulation assessment group increased significantly (73.5/min vs. 107.3/min, p < 0.001). State anxiety scores increased significantly both before (33.5 vs. 49.1, p < 0.001) and after (33.5 vs. 60, p < 0.001) the simulation assessment, compared to control. No linear relationship was found between any HRV variables and anxiety scores.

Conclusion

Participating in an emergency care simulation assessment significantly elevated levels of anxiety in a group of 36 students, however an objective measure of stress did not identify changes significantly different to those at rest, with the exception of heart rate. The high levels of anxiety documented before and after simulation assessments may have a negative effect on performance and require further investigation.

Association of the Number of a Simulation Faculty With the Implementation of Simulation-Based Education

INTRODUCTION

Although the implementation of simulation-based education (SBE) is essential for emergency medicine residency programs (EMRPs), little is known about the factors associated with its degree of SBE implementation in EMRPs. Therefore, this study aimed to investigate factors associated with SBE implementation in EMRPs. We hypothesized that the number of the simulation faculty was associated with the degree of SBE implementation.

METHODS

We conducted a multicenter, cross-sectional survey on SBE implementation in emergency medicine resident education, in accredited EMRPs in the Greater Tokyo area, Japan. Survey question themes included institutional characteristics and the status of simulation education in them. For analyzing factors associated with SBE implementation, we defined EMRPs with a robust SBE implementation as those having an annual simulation time exceeding 10 hours.

RESULTS

The survey response rate was 73% (115/158). Of the EMRPs that responded, 32% reported that their annual simulation time was more than 10 hours. In the unadjusted analysis, possession of a simulator in the emergency department was significantly associated with nonrobust SBE implementation, but the number of the simulation faculty was significantly associated. On adjusting for possession of a simulator in the emergency department, presence of simulation curriculum, and presence of simulation-based formative or comprehensive assessment, we observed an association of robust SBE implementation with a number of the simulation faculty (unit odds ratio = 1.33; 95% confidence interval = 1.10-1.60).

CONCLUSIONS

To our knowledge, this is the first Japanese study to demonstrate that the number of the simulation faculty at a program is independently associated with a robust SBE implementation.

Barriers and Solutions to Advancing Emergency Medicine Simulation-based Research: A Call to Action

Simulation technology has successfully improved patient safety and care quality through training and assessment of individuals, teams, and health care systems. Emergency medicine (EM) continues to be a leader and pioneer of simulation, including administration of simulation-based fellowships and training programs. However, EM simulation-based research has been limited by low rates of publication and poor methodologic rigor. The Society for Academic Emergency Medicine (SAEM) Simulation Academy is leading efforts to improve the quality of scholarship generated by the EM simulation community and to foster successful research careers for future generations of EM simulationists. Through a needs assessment survey of our membership and a year-long consensus-based approach, we identified two main clusters of barriers to simulation-based research: lack of protected time and dedicated resources and limited training and mentorship. As a result, we generated four position statements with implications for education, training, and research in EM simulation and as a call to action for the academic EM community. Recommendations include expansion of funding opportunities for simulation-based research, creation of multi-institutional simulation collaboratives, and development of mentorship and training pathways that promote rigor in design and methodology within EM simulation scholarship.

Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine

OBJECTIVES

Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT.

METHODS

The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT.

RESULTS AND ANALYSIS

Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT.

CONCLUSIONS/IMPLICATIONS FOR EDUCATORS

We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.

Perspectives on Priapism Education in Emergency Medicine

INTRODUCTION

Priapism is a urologic emergency managed by both emergency medicine (EM) providers and urologists. Attitudes regarding its management and understanding of education of non-urology trainees in this area are poorly defined.

AIM

The aim of this study was to describe attitudes toward priapism management among multiple stakeholders and define the current state of priapism education among EM residency programs.

METHODS

Surveys were developed and distributed online to EM residency leadership, EM residents, and urology providers. Each solicited attitudes and preferences regarding independent priapism management by EM providers. EM residents were further queried about their educational and clinical experiences in priapism management, and EM residency leadership were surveyed about their educational curricula. Responses among all 3 groups were compared using Fisher's exact tests.

MAIN OUTCOME MEASURE

Quantitative and descriptive responses were solicited regarding EM providers' management of acute ischemic priapism and current priapism curricula for EM residents.

RESULTS

91 EM residency program directors and assistant program directors (31.6% of programs), 227 EM residents (14.7% of programs), and 94 urologists (6.3% of survey recipients) responded. All geographic regions and all years of EM training were represented. Over 90% of all surveyed groups felt that EM providers should independently manage priapism in practice. 17% of senior EM residents felt "not at all" confident in managing priapism; and 25.5% had never primarily managed this entity in training. 81% of programs had a formalized priapism curriculum, of which 19% included treatment simulation. However, 36% of residents felt that current curricula were insufficient.

CLINICAL IMPLICATIONS

Widespread approval from both EM providers and urologists support EM-based management for uncomplicated cases of acute ischemic priapism. Current educational curricula for EM trainees may not be sufficient to prepare them to manage this entity in practice.

STRENGTHS & LIMITATIONS

This is the first study to examine provider attitudes toward EM-based management of priapism and assess the current state of education in this area with input from all key stakeholders. This survey was limited in its scope and the response rate was lower than desired.

CONCLUSION

Urologists support independent priapism management by EM providers, but an educational gap remains for EM trainees who do not feel adequately trained to manage this independently in practice. Dai JC, Franzen DS, Lendvay TS, et al. Perspectives on Priapism Education in Emergency Medicine. J Sex Med 2020;17:159-162.

Emergency medicine residency training in Africa: overview of curriculum

BACKGROUND

Emergency Medicine (EM) is a rapidly developing specialty in Africa with several emergency medicine residency-training programs (EMRPs) established across the continent over the past decade. Despite rapid proliferation of the specialty, little is known about emergency care curriculum structure and content. We provide an overview of Africa's EMRPs.

METHODS

This was a descriptive cross-sectional survey conducted of EMRPs in Africa between January 2017 and December 2017. Data were prospectively collected using a structured survey that was developed and administered through online data capture software, REDCap (Version 7.2.2, Vanderbilt, Nashville, TN, USA). Survey questions focused on curriculum structure and design, including clinical rotations, didactics, research, and evaluation. Data are summarized with descriptive statistics.

RESULTS

The survey was sent to the leadership of 15 EMRPs in 12 different African countries and 11 (73%) responded. Five (46%) of the responding programs were started by local non-EM trained faculty, two (18%) were started by international partners, and the remainder by a combination of local non-EM faculty and international partners. Overall, Seven (64%) of the countries offer a 4-year EMRP. In General, 40% of curriculums are influenced the contents developed by African Federation for Emergency Medicine. All programs offer resident led-didactics, with a median of 12 h (Interquartile range 9-6 h) per month. All EMRPs have a mandatory research requirement. All EMRPs offer clinical rotations in the ED, Paediatrics, and Obstetrics and Gynaecology, while only 2 programs offer rotations in radiology and neonatal intensive care units. Only 46% of EMRPs have in-ED clinical supervision by specialist.

CONCLUSION

The EMRPs in Africa were started by non-EM trained local faculty alone or collaboration with international partners. The curriculum offers most exposure to ED, and less exposure in radiology and neonatal intensive care. Residents are highly involved in leading didactics and less than half of the programs have in-ED specialist supervision of patient care.

Simulation-based medical training for paediatric residents in Italy: a nationwide survey

BACKGROUND

A prompt start to an appropriate neonatal and paediatric resuscitation is critical to reduce mortality and morbidity. However, residents are rarely exposed to real emergency situations. Simulation-based medical training (SBMT) offers the opportunity to improve medical and non-technical skills in a controlled setting. This survey describes the availability and current use of SBMT by paediatric residents in Italy with the purpose of understanding residents' expectations regarding neonatal and paediatric emergency training, and identifying gaps and potential areas for future implementation.

METHODS

A survey was developed and distributed to Italian residents. SBMT was defined as any kind of training with a mannequin in a contextualised clinically realistic scenario.

RESULTS

The response rate was 14.4%, covering the 71% of Italian paediatric residency programmes. Among them, 88% stated that Out of the 274 residents, 88% stated that they received less than 5 h of SBMT during the past training year, with 66% not participating in any kind of simulation activity. In 62% of the programmes no simulation training facility was available to residents. Among those who received SBMT, 46% used it for procedures and skills, 30% for clinical scenarios, but only 24% of them reported a regular use for debriefing. Of the overall respondents, 93% were interested in receiving SBMT to improve decision-making abilities in complex medical situations, to improve technical/procedural skills, and to improve overall competency in neonatal and paediatric emergencies, including non-technical skills. The main barriers to the implementation of SBMT programmes in Italian paediatric residencies were: the lack of experts (57%), the lack of support from the school director (56%), the lack of organisation in planning simulation centre courses (42%) and the lack of teaching materials (42%).

CONCLUSIONS

This survey shows the scarce use of SBMT during paediatric training programmes in Italy and points out the main limitations to its diffusion. This is a call to action to develop organised SBMT during paediatric residency programs, to train qualified personnel, and to improve the quality of education and care in this field.

Status Quo in Pediatric and Neonatal Simulation in Four Central European Regions: The DACHS Survey

INTRODUCTION

Simulation has acquired wide acceptance as an important component of education in health care and as a key tool to increase patient safety. This study aimed at identifying to what extent and how pediatric and neonatal simulation-based training (SBT) was being carried out in four Central European regions.

METHODS

We surveyed all pediatric and neonatal health care institutions in Germany, Austria, Switzerland, and South Tyrol on their current state of SBT using an online questionnaire.

RESULTS

We dispatched 440 questionnaires with a 45.9% response rate. Sixty-one percent (61.4%) of institutions performed SBT (algorithm training, 87.4%; skill training, 62.2%; high-fidelity SBT, 56.8%). Training was conducted interprofessionally at 88.9% of surveyed institutions. Physicians and nurses most often received SBT once per year. Lack of financial (62.2%) and personnel (54.1%) resources were the most frequent impediments to establish SBT.

CONCLUSIONS

Although delivered heterogeneously, widespread use of pediatric simulation and a considerable number of already existing SBT programs are the key findings of this survey. These data are encouraging enough to promote more effective networking in simulation-based research, education, training, and quality improvement, as we aim to ultimately increase patient safety for neonates, infants, and children.

Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study

INTRODUCTION

Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR).

METHODS

We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM.

RESULTS

Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved.

CONCLUSION

Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.

Evaluation of Technical Competency in Healthcare Simulation (E-TeCHS) tool: a modified Delphi study

Background

Graduates of simulation fellowship programmes are expected to have the ability to perform a variety of simulation specific skills at the time of graduation. Currently, simulation fellowship directors have access to tools to assess the ability of a fellow to debrief learners. However, there is no tool to assess a simulation fellow’s competency in technical skills. The purpose of our manuscript was to develop and obtain content validation of a novel instrument designed to assess a simulation fellow’s ability to perform the five core simulation technical skills.

Methods

The study protocol was based on a methodology for content validation of curriculum consensus guidelines. This approach involves a three-step process, which includes the initial delineation of the curricular content. This was then followed by the validation of the curricular content using survey methodology and lastly obtaining consensus on modifications using Delphi methodology.

Results

Two rounds of modified Delphi methodology were performed. Seventy-four respondents provided feedback on the round 1 survey and 45 respondents provided feedback on round 2. The final assessment tool has five elements and 16 subitems with four optional subitems.

Conclusion

The Evaluation of Technical Competency in Healthcare Simulation tool provides an instrument developed from a national consensus of content experts. This tool provides simulation fellowship directors a method to evaluate fellows’ competency in technical skills.

A needs assessment for simulation-based training of emergency medical providers in Nebraska, USA

Background

Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program.

Methods

The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants’ perceived training gaps; (2) based on the findings from the focus group, a needs assessment survey was constructed and sent to all EMS and ED staff in Nebraska; and (3) 1395 surveys were completed and analyzed.

Results

Thematic areas of training gaps included cardiopulmonary conditions, diabetes management, mass casualty incidents (MCI), maternal health and child delivery, patient assessment, pediatric care (PC), and respiratory emergency care. Gaps in non-clinical skills were related to crisis management such as maintaining effective teamwork. Participants frequently identified cardiopulmonary care, PC, and MCI as highly needed trainings. Other needs included life support-related retaining courses, sessions informing protocol updates, the availability of retraining tailored for rural areas, substance use-related emergencies, and farming-related injuries.

Conclusion

EMS and ED staff identified several skill gaps and training needs in the provision of emergency services in rural communities. These results allow for the development of customized training curricula and, with the help of an on-site simulation-based program, can identify gaps in health professionals’ skills, knowledge, and abilities and thus help them respond to acute healthcare needs of rural communities.

Development and Utilization of 3D Printed Material for Thoracotomy Simulation

Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).

Challenging Hazards Amidst Observational Simulation in the Emergency Department: Advancing Gamification in Simulation Education Through a Novel Resident-led Skills Competition

Medical simulation competitions have become an increasingly popular method to provide a hands-on “gamified” approach to education and training in the health professions. The most well-known competition, SimWars, consists of well-coordinated teams that are tasked with completing a series of mind-bending clinical scenarios in front of a live audience through ‘bracket-style’ elimination rounds. Similarly, challenging hazards amidst observational simulation (CHAOS) in the emergency department (ED) is another novel approach to gamification in both its structure and feel. Conducted at the Council of Emergency Medicine Resident Directors (CORD) 2018 National Assembly in San Antonio, Texas, instead of assigning premeditated teams, it placed random Emergency Medicine (EM) faculty, residents, and medical students together in teams to test them on a variety of fundamental EM content areas. Additionally, the event incorporated multiple levels within each round, allowing the inclusion of additional information to be shared with participants to support “switching gears,” as is typical for teams working in the ED and augmenting the perceived level of “chaos.”

To assess this pilot project, formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the intervention was obtained through an eight-item questionnaire using a five-point Likert-type scale from 19 of the 20 enrolled participants (95% response rate). Responses were generally positive with an overall course rating score of 4.45 out of 5 (SD +/- 0.62). Qualitative feedback revealed that learners enjoyed performing procedures and networking with their EM colleagues. The majority of residents (95%) recommend the activity be integrated into subsequent conferences. Areas for improvement included shorter cases and minimizing technical malfunctions.

CHAOS in the ED was a successful pilot study that incorporated gamification as a means to deploy simulation-based training at a national emergency medicine conference in a community of simulation educators. Future studies should focus on incorporating learners’ feedback into subsequent CHAOS iterations and reducing overhead costs to increase its adoption by both regional and national audiences.

A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of "see one, do one, teach one" is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model.

Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters

The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.

Using a Standardized Client Encounter in the Veterinary Curriculum to Practice Veterinarian-Employer Discussions about Animal Cruelty Reporting

Animal cruelty is the antithesis of animal welfare. Because veterinarians take an oath to protect animal welfare, they are professionally obligated to report animal cruelty. Several US states have mandatory reporting laws for veterinarians, and both the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association support reporting. Some state veterinary practice acts, such as Arizona's, also require reporting. Despite this, animal cruelty is not always emphasized in veterinary curricula. As a result, not all veterinary students and graduates feel comfortable recognizing signs of animal cruelty and may not be aware of the resources that are available to them when considering reporting. AVMA suggests that practices develop their own protocols for identifying signs that patients may have been victims of cruelty and consulting on cases with senior colleagues with regard to when to report. To enhance student comfort with these conversations, Midwestern University College of Veterinary Medicine developed a standardized client encounter titled "Grizabella's Final Fight." I hope that other colleges of veterinary medicine will adapt this teaching tool to allow students the opportunity to practice discussions surrounding animal cruelty reporting in the context of state-specific legislation that guides their code of professional conduct.

Place de la simulation dans la formation initiale des urgentistes : enquête nationale observationnelle

Introduction : La simulation apparaît aujourd’hui comme un outil indispensable dans l’apprentissage de compétences médicales techniques et non techniques, tout en respectant le principe éthique suivant : « Jamais la première fois sur le patient ». Actuellement, l’intégration de la simulation dans les programmes de formation des internes de médecine d’urgence est disparate : son cadre demeure à définir devant l’ouverture récente du diplôme d’études spécialisée (DES) de médecine d’urgence à l’automne 2017.

Objectif de l’étude : Cette étude a évalué l’utilisation de la simulation en France dans l’enseignement actuel de la médecine d’urgence, afin d’initier une réflexion sur la place que pourrait avoir ce type d’enseignement pour le DES.

Méthode : Il s’agissait d’une étude observationnelle multicentrique. Un questionnaire a été envoyé par e-mail à l’ensemble des responsables universitaires de France impliqués dans l’enseignement de la médecine d’urgence. Les données ont été colligées dans Excel (Microsoft). Elles étaient à la fois quantitatives et qualitatives et concernaient le cadre, la structuration et le contenu de la formation par la simulation.

Résultats : Vingt-cinq facultés de médecine sur 29 ont répondu au questionnaire. Parmi elles, 23 utilisaient la simulation (soit 92 %), dont 22 la simulation haute fidélité et 21 la simulation procédurale. Arrêt cardiorespiratoire (22), état de choc (21), douleur thoracique et tachycardies (20), traumatisé crânien et traumatisé grave (17) étaient les thématiques majoritairement abordées. Les gestes techniques les plus enseignés étaient : intubation (22), intubation difficile (21), ventilation assistée-contrôlée et voie intraosseuse (18). En médiane, la formation comptait entre deux et trois jours de simulation par année de formation. Par ailleurs, dans 12 centres (soit 52 %), les formateurs avaient un temps professionnel dédié, et 15 centres (soit 65 %) bénéficiaient de personnel salarié. Enfin, seulement 12 centres (52 %) estimaient « plutôt » respecter l’adage « Jamais la première fois sur le patient ».

Discussion : L’utilisation de la simulation dans l’enseignement de la médecine d’urgence est inégale. Les responsables pédagogiques interrogés semblent tomber d’accord quant aux principales thématiques et techniques à aborder. Le développement de la simulation semble souhaité de tous, mais demeure complexe en raison notamment de l’investissement humain et matériel que cela représente. Ces réponses pourraient fournir un axe de réflexion afin d’établir un programme de simulation commun à l’ensemble des facultés.

Review of Simulation Training in Interventional Radiology

Simulation training has evolved and is now able to offer numerous training opportunities to supplement the practice of and overcome some of the shortcomings of the traditional Master-Apprentice model currently used in medical training. Simulation training provides new opportunities to practice skills used in clinical procedures, crisis management scenarios, and everyday clinical practice in a risk-free environment. Procedural and nonprocedural skills used in interventional radiology can be taught with the use of simulation devices and technologies. This review will inform the reader of which clinical skills can be trained with simulation, the types of commercially available simulators and their educational validity, and the assessment tools used to evaluate simulation training.