Developing a Longitudinal Cultural Competency Curriculum

Learning Objectives: Enhance EM resident cultural competence through the acquisition of knowledge, skills, and attitudes to effectively care for all patients. Objectives were developed using Bloom’s taxonomy for each module within the curriculum.Background: Training has been found to improve knowledge of cultural and behavioral aspects of healthcare and build effective communication skills. To the best of our knowledge, this is the first longitudinal cultural competency curriculum to be studied in EM residents.Objectives: Enhance EM resident cultural competence through the acquisition of knowledge, skills, and attitudes to effectively care for all patients. Objectives were developed using Bloom’s taxonomy for each module within the curriculum.Curricular Design: Learners are 18 EM interns at a single urban 3-year program. Our 12-month curriculum was developed using Kern’s 6-step model. A general needs assessment was conducted via literature search and consultation with experts in the field. A targeted needs assessment was performed using the validated Clinical Cultural Competency Questionnaire. Based on these results, 12 sessions were created: implicit bias; social determinants of health, race and antiracism; microaggressions; obtaining a culturally sensitive history; using interpreters; advocacy for undocumented immigrants; LGBTQ patients; ED management of sexual assault; gender disparities; social workers in the ED; and palliative care. Educational methods include lectures, simulation, facilitated discussions, problem-based learning, and journal club readings. Impact will be assessed through quarterly administration of the Tool for Assessing Cultural Competency Training (TACCT), a tool created by the AAMC. Further evaluation will be conducted through satisfaction surveys and the Program Evaluation Committee.Impact: 3 initial sessions for the 2021-2022 year have successfully fulfilled several domains identified by the TACCT. Sessions were well received by learners. 94% of learners described the first session “Using Interpreters” as helpful, 100% recommended it for future orientations, and 72% reported learning new skills that they planned to incorporate in future patient encounters

The Power of an Active Shooter Simulation: Changing Ethical Beliefs

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.Methods: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.Results: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.Conclusion: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain

The Power of an Active Shooter Simulation: Changing Ethical Beliefs

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.Methods: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.Results: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.Conclusion: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain

Considering Burnout and Well-Being: Emergency Medicine Resident Shift Scheduling Platform and Satisfaction Insights from a Quality Improvement Project

Few studies explore emergency medicine (EM) residency shift scheduling software as a mechanism to reduce administrative demands and broader resident burnout. A local needs assessment demonstrated a learning curve for chief resident schedulers and several areas for improvement. In an institutional quality improvement project, we utilized an external online cross-sectional convenience sampling pilot survey of United States EM residency programs to collect information on manual versus software-based resident shift scheduling practices and associated scheduler and scheduler-perceived resident satisfaction. Our external survey response rate was 19/253 (8%), with all United States regions (i.e., northeast, southeast, midwest, west, and southwest) represented. Two programs (11%) reported manual scheduling without any software. ShiftAdmin was the most popularly reported scheduling software (53%). Although not statistically significant, manual scheduling had the lowest satisfaction score and programs with ≤30 residents reported the highest levels of satisfaction. Our data suggest that improvements in existing software-based technologies are needed. Artificial intelligence technologies may prove useful for reducing administrative scheduling demands and optimizing resident scheduling satisfaction