Beyond "Taking" a History: Narrative Implications of the Electronic Health Record for Patients

"Synapsis: A Health Humanities Journal" was founded in 2017 by Arden Hegele, a literary scholar, and Rishi Goyal, a physician. Its mission is to develop conversations among diverse people thinking about medical and humanistic ways of knowing ... as a “Department Without Walls” that connects scholars and thinkers from different spheres

A Community Mural Tour: Facilitating Experiential Learning About Social Determinants of Health

To successfully provide effective patient care within a healthcare system and broader society facing health inequities and social injustice, emergency medicine (EM) residents must demonstrate a nuanced understanding of social determinants of health (SDOH). Classroom or bedside instruction may be insufficient to generate meaningful engagement with patients’ social contexts; experiential collaborative learning with community engagement has been suggested as an ideal modality for education about SDOH. We describe a low-cost, easily replicable activity involving observation and discussion of community murals within built environments. The tour was planned by EM faculty with expertise in graduate medical education, social EM, and the use of art in medical education. Prior to the activity, faculty selected murals situated in a variety of neighborhoods that would spark discussion on SDOH. Over the two-hour tour, residents stopped at city murals on a pre-planned route and engaged in observation and discussion. Faculty facilitators used established arts pedagogy, including visual thinking strategies and the concept of the “third thing,” to facilitate a collaborative exploration of murals, surrounding communities, and larger implications for patients. The activity was successful in providing residents with a nuanced, context-specific approach to SDOH, sparking greater curiosity about the communities they serve, and engaging residents in reflection and conversation about personal preconceptions and how to better engage with surrounding communities. Since murals and street art are present and accessible in many different settings, residency programs could consider implementing a similar activity as part of their didactic curriculum

A Community Mural Tour: Facilitating Experiential Learning About Social Determinants of Health

To successfully provide effective patient care within a healthcare system and broader society facing health inequities and social injustice, emergency medicine (EM) residents must demonstrate a nuanced understanding of social determinants of health (SDOH). Classroom or bedside instruction may be insufficient to generate meaningful engagement with patients’ social contexts; experiential collaborative learning with community engagement has been suggested as an ideal modality for education about SDOH. We describe a low-cost, easily replicable activity involving observation and discussion of community murals within built environments. The tour was planned by EM faculty with expertise in graduate medical education, social EM, and the use of art in medical education. Prior to the activity, faculty selected murals situated in a variety of neighborhoods that would spark discussion on SDOH. Over the two-hour tour, residents stopped at city murals on a pre-planned route and engaged in observation and discussion. Faculty facilitators used established arts pedagogy, including visual thinking strategies and the concept of the “third thing,” to facilitate a collaborative exploration of murals, surrounding communities, and larger implications for patients. The activity was successful in providing residents with a nuanced, context-specific approach to SDOH, sparking greater curiosity about the communities they serve, and engaging residents in reflection and conversation about personal preconceptions and how to better engage with surrounding communities. Since murals and street art are present and accessible in many different settings, residency programs could consider implementing a similar activity as part of their didactic curriculum

A Longitudinal Performance Portfolio Combining Real-Time Clinical Outcomes Data with Narrative Self-Reflection for Emergency Medicine Residents

Learning Objectives: To describe a unique data-informed structured portfolio which encourages EM residents to intentionally self-evaluate, develop goals tailored to educational priorities, reflect on clinical rotations, and plot longitudinal progress to gain competency in practice-based learning and improvement.Introduction: Self-evaluation is a key component of emergency medicine residents’ growth and an important element of the ACGME practice-based learning and improvement (PBLI) sub-competencies, but is infrequently structured and rarely incorporates objective data on clinical outcomes.Educational Objectives: To facilitate proficiency in PBLI, we aim to provide residents with a data-informed structured portfolio to encourage intentional self-evaluation, develop goals tailored to educational priorities, provide a space to reflect on clinical rotations and plot longitudinal progress.Curricular Design: We developed Growth Charts for residents to reflect on patient outcomes drawn from a novel feedback platform: Linking Outcomes Of Patients (LOOP). LOOP uses EHR data to generate unbiased daily reports of individual clinicians’ patient outcomes including 72-hour return ED visits, 48-hour inpatient level-of-care escalations and in-hospital deaths. Growth Charts encourage narrative reflection after each rotation with open-ended prompts targeting strengths, areas for improvement, clinical self-perception, goals for subsequent rotations, and strategies for achieving goals. Additional prompts querying unexpected patterns in patient outcomes, potential contributing factors and intended future practice modifications promote the incorporation of LOOP data into narrative reflections.Impact/Effectiveness: A pilot cohort of ten PGY1-4 residents volunteered in AY2020-21. To date, participants have reflected on 67% of potential rotations (range 0-100%; median 88%), analyzing unexpected outcomes, practicing goal setting and developing strategies to achieve goals. Pilot participation was associated with a nearly 4-fold increase in LOOP engagement compared to non-participants (RR 3.68; 95%CI 1.75-7.73). A hybrid structured narrative reflection combined with objective outcomes data demonstrates promise in furthering EM residents’ PBLI competency

Assessment of Emergency Medicine Residents’ Situational Awareness and Perception of Patient Safety Culture in the Emergency Department

Learning Objective: 1. Assess the baseline comfort for EM residents identifying and rectifying patient safety hazards 2. Assess the EM residents baseline ED safety climate.Background: Situational awareness (SA) is crucial in emergency medicine (EM) and to patient safety. SA refers to perceptions and understanding of the environment. Little is known about EM trainees’ SA and perception of Emergency Department (ED) safety climate.Objectives: Our objective was to evaluate EM residents’ perception of ED safety climate and their self-reported SA; we hypothesized that both would be low.Methods: A cross-sectional observational study was conducted over 3 months at 2 university-affiliated 3-year EM programs. A convenience sample of residents completed the validated self-reported Situational Awareness Rating Technique (SART) measure after the resuscitation of an ED or simulated patient. The safety climate portion of the Safety Attitudes Questionnaire and a survey assessing comfort with identifying and rectifying hazards in the ED were completed Descriptive statistics were used for SART, safety climate, and comfort. A Spearman-Rho correlation coefficient was calculated to assess the correlation between PGY and SA, PGY and comfort, and the correlation between comfort and SA.Results: 51/91 residents completed a SART for a total of 62 SARTs; 10 residents completed more than one SART. The mean SART score was 13.4 (max 21). 64/91 residents completed the safety climate scale; 57.8% of participants identified a positive safety climate. 46.0% and 41.3% reported being somewhat or very comfortable identifying and rectifying hazards, respectively. There was no correlation between PGY and SA (r=0.163,p=0.25). There was a correlation between PGY and comfort with identifying (r=0.252,p=0.046) and rectifying hazards (r=0.252,p=0.046).Conclusions: Less than 50% of residents reported comfort with identifying and rectifying hazards and only a slight majority reported a positive ED safety climate. Comfort modestly improved throughout residency, while SA did not. This data suggests a need for longitudinal patient safety curriculum