Les résidents de première année en médecine d’urgence pratiquent-ils assez de réanimations et d’autres procédures cliniques pour répondre aux exigences d’un cursus de compétence par conception?

Background: With the transition to a Competence by Design (CBD) curriculum, Fellow of the Royal College of Physicians in Emergency Medicine (FRCP-EM) training has created guidelines on experiences residents should have before progressing. We sought to quantify adult medical resuscitations and clinical procedures completed by PGY1 FRCP-EM residents to compare them to CBD requirements with the aim to identify areas of limited exposure requiring curriculum revisions prior to nation-wide CBD implementation. Methods: Twenty-two PGY1 residents from four FRCP-EM programs recorded their activities from July 2017 to June 2018 in an online log that tracked resuscitations and procedures along with role assumed, supervision, and level of comfort. Results: In total 515 resuscitations were logged with the median number per resident 15 (range 0 to 98). The most frequent resuscitation was altered mental status and the least was unstable dysrhythmia. 557 total procedures were logged with the median number 75 (range 8 to 273). The most frequent procedure done was simple laceration repair and the least frequent was intraosseous access. Conclusions: Unstable dysrhythmias and cardiorespiratory arrest along with intraosseous access and arthrocentesis are low event clinical exposures. In the era of CBD, the misalignment of entrustrable professional activity (EPA) targets and curriculum delivery should be monitored/reviewed to ensure expectations are realistic and that sufficient exposures are available.Contexte: Dans le cadre de la transition vers un programme d’études axé sur la compétence par conception (CPC), la formation pour devenir Fellow of the Royal College of Physicians en médecine d’urgence (FRCP-EM) a créé des lignes directrices sur l’expérience que les résidents devraient avoir avant de progresser. Nous avons tenté de quantifier les réanimations médicales d’adultes et les procédures cliniques effectuées par les résidents de première année de la formation postdoctorale en FRCP-EM pour les comparer aux exigences du programme de CPC dans le but d’identifier les domaines où l’exposition est limitée, nécessitant une révision du programme d’études avant la mise en œuvre de la CPC à l’échelle nationale. Méthodes : De juillet 2017 à juin 2018 vingt-deux résidents de première année de 4 programmes FRCP-EM ont entré dans un journal en ligne chaque réanimation ou procédure pratiquée ainsi que des informations comme le rôle qu’ils avaient assumé, la supervision et le niveau de confort éprouvé. Résultats : Au total, 515 réanimations ont été enregistrées, le nombre médian par résident étant de 15 (de 0 à 98). La réanimation la plus fréquente était l’altération de l’état mental et la moins fréquente était la dysrythmie instable. Parmi les 557 autres procédures enregistrées, avec un nombre médian de 75 (de 8 à 273), la plus fréquente était la réparation de lacérations simples et la moins fréquente était l’accès intra-osseux. Conclusions : Les dysrythmies instables et les arrêts cardio-respiratoires ainsi que l’accès intra-osseux et l’arthrocentèse sont pratiqués en faible nombre. À l’ère de la CPC, le décalage entre les ciblesd’activités professionnelle confiable (EPA) et le cursus proposé dans le programme d’études devrait être surveillé ou revu pour s’assurer que les attentes sont réalistes et que les résidents ont accès à une exposition suffisante

Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

Abstract Background There are few recommendations about the use of cardiac markers in the investigation and management of atrial fibrillation/flutter. Currently, it is unknown how many patients with atrial fibrillation/flutter undergo troponin testing, and how positive troponin results are managed in the emergency department. We sought to look at the emergency department troponin utilization patterns. Methods We performed a retrospective chart review of patients with atrial fibrillation/flutter presenting to the emergency department at three centers. Outcome measures included the rates of troponins ordered by emergency doctors, number of positive troponins, and those with positive troponins treated as acute coronary syndrome (ACS) by consulting services. Results Four hundred fifty-one charts were reviewed. A total of 388 (86%) of the patients had troponins ordered, 13.7% had positive results, and 4.9% were treated for ACS. Conclusions Troponin tests are ordered in a high percentage of patients with atrial fibrillation/flutter presenting to emergency departments. Five percent of our total patient cohort was diagnosed as having acute coronary syndrome by consulting services

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Abstract Background To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). Methods In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. Implementation. Results The needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs. Conclusion We have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs

Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum?

Background: With the transition to a Competence by Design (CBD) curriculum, Fellow of the Royal College of Physicians in Emergency Medicine (FRCP-EM) training has created guidelines on experiences residents should have before progressing. We sought to quantify adult medical resuscitations and clinical procedures completed by PGY1 FRCP-EM residents to compare them to CBD requirements with the aim to identify areas of limited exposure requiring curriculum revisions prior to nation-wide CBD implementation.Methods: Twenty-two PGY1 residents from four FRCP-EM programs recorded their activities from July 2017 to June 2018 in an online log that tracked resuscitations and procedures along with role assumed, supervision, and level of comfort.Results: In total 515 resuscitations were logged with the median number per resident 15 (range 0 to 98). The most frequent resuscitation was altered mental status and the least was unstable dysrhythmia. 557 total procedures were logged with the median number 75 (range 8 to 273). The most frequent procedure done was simple laceration repair and the least frequent was intraosseous access.Conclusions: Unstable dysrhythmias and cardiorespiratory arrest along with intraosseous access and arthrocentesis are low event clinical exposures. In the era of CBD, the misalignment of entrustrable professional activity (EPA) targets and curriculum delivery should be monitored/reviewed to ensure expectations are realistic and that sufficient exposures are available.Contexte : Dans le cadre de la transition vers un programme d’études axé sur la compétence par conception (CPC), la formation pour devenir Fellow of the Royal College of Physicians en médecine d’urgence (FRCP-EM) a créé des lignes directrices sur l’expérience que les résidents devraient avoir avant de progresser. Nous avons tenté de quantifier les réanimations médicales d’adultes et les procédures cliniques effectuées par les résidents de première année de la formation postdoctorale en FRCP-EM pour les comparer aux exigences du programme de CPC dans le but d’identifier les domaines où l’exposition est limitée, nécessitant une révision du programme d’études avant la mise en œuvre de la CPC à l’échelle nationale.Méthodes : De juillet 2017 à juin 2018 vingt-deux résidents de première année de 4 programmes FRCP-EM ont entré dans un journal en ligne chaque réanimation ou procédure pratiquée ainsi que des informations comme le rôle qu’ils avaient assumé, la supervision et le niveau de confort éprouvé.Résultats : Au total, 515 réanimations ont été enregistrées, le nombre médian par résident étant de 15 (de 0 à 98). La réanimation la plus fréquente était l’altération de l’état mental et la moins fréquente était la dysrythmie instable. Parmi les 557 autres procédures enregistrées, avec un nombre médian de 75 (de 8 à 273), la plus fréquente était la réparation de lacérations simples et la moins fréquente était l’accès intra-osseux.Conclusions : Les dysrythmies instables et les arrêts cardio-respiratoires ainsi que l’accès intra-osseux et l’arthrocentèse sont pratiqués en faible nombre. À l’ère de la CPC, le décalage entre les cibles d’activités professionnelle confiable (EPA) et le cursus proposé dans le programme d’études devrait être surveillé ou revu pour s’assurer que les attentes sont réalistes et que les résidents ont accès à une exposition suffisante

Additional file 1: of Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Curriculum for Post Graduate Study on Emergency Medicine. (PDF 236 kb

Additional file 3: of Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Brief Explanation of CanMEDS/EthioMEDS roles. (PDF 84 kb

Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia

Background Ethiopian emergency department (ED) patients have a considerable burden of illness and injury for which all-cause mortality rates have not previously been published. This study sought to characterize the burden of and to identify predictors for early all-cause mortality among patients presenting to the Tikur Anbessa Specialized Hospital ED (TASH-ED) in Ethiopia. Methods Data was prospectively collected from the records of all patients who died within 72 h of ED presentation. Pearson’s Chi square and Fisher’s exact tests were used to investigate associations between two outcome variables: (a) time to death and (b) immediate cause of death in relation to specific demographic and clinical factors. Time from ED presentation to death was dichotomized as ‘very early’ mortality within ≤6 h and death >6–72 h and logistic regression was used to assess the adjusted impact of these demographic and clinical variables on the probability of dying within 6 h of ED presentation. Results Between October 2012 and May 2013, 9956 patients visited the ED and 220 patients died within 72 h of admission. After excluding patients dead on arrival (n = 34), the average age of death was 43.1 years and the overall mortality rate was 1.9 %. Head injury (21.5 %) and sepsis (18.8 %) were the most common causes of death. Relative to medical patients, trauma patients were more likely to be male (p 48 h vs. <4 h: OR = 0.27, 95 % CI 0.09, 0.81, p = 0.02). Conclusions The mortality burden of trauma and sepsis in the TASH-ED is substantial, and mortality patterns differ between these groups. As emergency medicine develops as a specialty in the Ethiopian health system, the potential impact of context-specific clinical care protocol development, trauma prevention advocacy and ED care re-organization initiatives to reduce mortality among these young, previously well patients warrants exploration

Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Abstract Background To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). Methods In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. Implementation. Results The needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs. Conclusion We have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs