An Evaluation of Risk Attitudes and Risk Tolerance in Emergency Medicine Residents

An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients? These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of medical professionals could be critical. If EM residents have great risk aversion, they might practice defensive medicine, thereby incurring crippling costs4. On the other hand, if emergency medicine residents are greatly risk tolerant, they may make decisions that lead to significant morbidity and mortality. It is essential to establish a baseline risk profile before any corrective measures can be advanced. This study attempted to accomplish precisely that using Risk Type CompassTM.https://jdc.jefferson.edu/cwicposters/1023/thumbnail.jp

Sepsis Education and Training in Medical School

Purpose: According to the National Institutes of Health, severe sepsis strikes more than one million Americans every year. Despite the extensive research that has gone into creating the different risk stratification tools for sepsis, there is still a fifteen to thirty percent mortality rate among patients diagnosed with sepsis. We believe this is due to a lack of robust education and training of medical students in sepsis identification, and thus, the purpose of this study was to determine the extent of training and education of medical students in the identification and treatment of sepsis. Methods: This study is aimed at the first-year residents at emergency medicine programs nationwide. Using the Qualtrics software available on the Thomas Jefferson University commons, we created a twenty-one question survey that collected data on knowledge, skills, and attitudes of first-year residents towards sepsis diagnosis and treatment, based on what they have formally learned in medical school. Thus far, we are continuing to collect data. Once data has been collected, we will undergo quantitative and qualitative analysis. Results and Conclusions: As of writing this abstract, we continue to collect data due to unforeseen circumstances. We will soon have data that can be analyzed. We believe the data will show a lack of robust curriculum at medical schools nationwide for the training of medical students in the diagnosing and treatment of sepsis. If this is proven true, programs can be created to add sepsis curriculum to formal medical education

Assessing the use of social media in physician assistant education.

Objectives: This study aims to assess physician assistant (PA) students\u27 experiences with social media (SM) as a part of their medical education. Methods: The study is split into two phases: Phase 1- A cross-sectional survey emailed to all PA students at four PA school campuses to assess students\u27 prior SM experiences (226 responses, 71.1% response rate); and Phase 2- Inclusion of SM educational resources, via Twitter, within lectures performed at two PA schools. A phase-2 survey assessed students\u27 opinions of educational SM (50 responses, 59.5% response rate) and SM usage was tracked. Results: The phase-1 survey respondents indicated that 97.3% (n=220) use social media; often used as a part of their education, 65% (n=147) informally and 2.7% (n=6) formally incorporated. Students most commonly use Facebook, YouTube, and Instagram, but rarely use Twitter. Currently using SM for medical education was significantly associated with predicting that future PA education will formally include SM [r Conclusions: Many PA students are currently using various forms of social media to augment their education. Most PA students support formal incorporation of social media into their education. PA educators should consider using our data and methods of social media inclusion when designing curricula and while clinically precepting PA students

Basic Life Support and Opioid Overdose Management: Knowledge and Attitudes Among Students Matriculating into Medical School - A Cross-Sectional Analysis to Inform Curricular Change

Purpose: While Basic Life Support (BLS) skills are typically included in undergraduate medical education (UME) curricula, graduating students continue to demonstrate substandard skills retention. In the setting of the opioid epidemic, effective opioid overdose management (OOM) training should likewise take place during UME. To date, there is a paucity of literature that describes incoming medical students’ knowledge and attitudes on these topics prior to beginning their studies. The purpose of this study is to describe medical students’ knowledge and attitudes towards BLS and OOM prior to their medical training to inform curricular change in UME. Methods: We conducted an observational, cross-sectional study of 1st-year medical students at a major academic medical school in Philadelphia, the epicenter of the opioid epidemic. Survey items assessed participants’ knowledge and attitudes on BLS and OOM. The survey was voluntary and deployed through Qualtrics. Results and Conclusions: 258 students of 272 (95% response rate) completed the survey. 32% of respondents had been previously certified in BLS / ACLS, and only 15% had previously received any level of OOM training. Students reported a moderate comfort level with administering chest compressions (5.14 [Likert Scale 1-10, 10=most comfortable]); and a low comfort level using an AED (4.80 3.1) or assisting an opioid victim (3.74 3.1). Up to 74% failed to correctly answer knowledge-based questions regarding basic management principles. Matriculating students do not have adequate BLS or OOM knowledge upon entering medical school, but wish to have these skills taught to them during their pre-clinical training. Findings should inform UME curricular changes to address the growing opioid epidemic

Ελληνικά προγράμματα Ιδιωτικοποιήσεων υπό το πρίσμα του Δικαίου των Κρατικών Ενισχύσεων

Το δίκαιο των κρατικών ενισχύσεων αποτελεί ένα sui generis θεσμό της ενωσιακής έννομης τάξης, ο οποίος εντάσσεται στο ευρύτερο πλαίσιο του δικαίου του ανταγωνισμού. Οι κανόνες που εφαρμόζονται στο πλαίσιο του δικαίου των κρατικών ενισχύσεων φέρνουν στη θέση του ελεγχομένου, όχι μόνο την επιχείρηση, όπως στο δίκαιο του ανταγωνισμού αλλά και το κράτος ως πηγή οικονομικής φύσης ενισχύσεων που δύνανται να παρεμποδίσουν τη λειτουργία του ανταγωνισμού εντός της Ενιαίας Αγοράς. Ο αντίκτυπος του δικαίου των κρατικών ενισχύσεων, συνεπώς, δεν είναι μόνο νομικός και οικονομικός αλλά έχει και πολιτικές προεκτάσεις. Οι ιδιωτικοποιήσεις αποτελούν τη βασική επιλεγόμενη μέθοδο περιορισμού της κρατικής παρεμβατικότητας στην οικονομία και, ταυτόχρονα, μία εκ των βασικότερων εκφράσεων της θεωρίας της ελεύθερης αγοράς. Η Ελληνική Δημοκρατία, προσπαθώντας να εναρμονιστεί με τις επιταγές της οικονομίας της ελεύθερης αγοράς, εκπόνησε και εφάρμοσε σειρά προγραμμάτων ιδιωτικοποίησης δημοσίων επιχειρήσεων και τομέων της αγοράς, τόσο κατά την εφαρμογή των προγραμμάτων δημοσιονομικής προσαρμογής όσο και προηγουμένως. Η παρούσα διπλωματική εργασία φιλοδοξεί, να βοηθήσει τον αναγνώστη, να αποκρυσταλλώσει τη μέθοδο και τα βήματα του ελέγχου της εφαρμογής των κανόνων του δικαίου των κρατικών ενισχύσεων, με τη βοήθεια μερικών εκ των σημαντικότερων ελληνικών προγραμμάτων ιδιωτικοποίησης. Περιγράφει τα επί μέρους στοιχεία που συναποτελούν την εννοιολογική σύσταση των κρατικών ενισχύσεων, όπως αυτά εξάγονται από την απαγορευτική διάταξη της παραγράφου 1 του άρθρου 107 της ΣΛΕΕ και όπως αυτά εμφανίζονται στα προγράμματα ιδιωτικοποιήσεων κατά το νομικό του έλεγχο από την Επιτροπή, το ΓενΔΕΕ και το ΔΕΕ. Παράλληλα, ευελπιστεί να προβάλλει το ρόλο και τη σημασία των ελληνικών προγραμμάτων ιδιωτικοποιήσεων, υπό το φως των κανόνων του δικαίου των κρατικών ενισχύσεων, αναδεικνύοντας τη θέση των δύο ως βασικών μεθόδων απεμπλοκής του κράτους από την παρέμβαση του στην οικονομία. Ταυτόχρονα, προσβλέπει στην κατανόηση της θέσης του δικαίου των κρατικών ενισχύσεων τόσο ως αποτρεπτικό παράγοντα των πιθανών εθνικών βλέψεων για οικονομική κυριαρχία και επιρροή εντός της ενιαίας αγοράς και της Ευρωπαϊκής Ένωσης, όσο και παράγοντα εμπέδωσης και προστασίας της λειτουργίας του ελεύθερου ανταγωνισμού στην αγορά, παρεμποδίζοντας τη διαμόρφωση μίας ευνοιοκρατικής οικονομίας.State Aid Rules is a sui generis institution of the EU legal order, which is part of the broader framework of Competition Law. The rules applicable under State Aid law place not only the undertaking, as in competition law, as being screened, but also the member-state as the source of the economic nature of aid which may hinder the functioning of competition within the Internal Market. The impact of State Aid law, therefore, is not only legal and economic but also has political implications. Privatization is the main chosen method of reducing state intervention in the economy and, at the same time, one of the most basic expressions of free market theory. The Hellenic Republic, trying to harmonize with the requirements of the free market economy, has developed and implemented a series of privatization programs for public enterprises and market sectors, both during the implementation of the fiscal adjustment programs and before them. This dissertation aims to help the reader, to crystallize the method and steps of controlling the application of the State aid rules, with the help of some of the most important Greek privatization programs. Describes the elements that constitute the conceptual composition of State Aid, as they are derived from the prohibition provision of paragraph 1 of Article 107 TFEU and as they appear in the privatization programs during its legal control by the Commission, the EGC and the CJEU This dissertation tries to highlight the role and importance of Greek privatization programs, in the light of the State Aid rules, by also highlighting the position of the two as the main methods of disengaging the state from its intervention in the economy. At the same time, it looks forward to understanding the position of State Aid law as both a deterrent to possible national aspirations for economic sovereignty and influence within the internal market and the European Union, and a factor in consolidating and protecting the functioning of free competition in the market and in preventing shaping an economy based on favoritism

Trauma to the Eye -A Low Fidelity Resident Teaching Module for Identifying and Treating a Retrobulbar Hematoma.

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH. Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform a physical examination that was consistent with a 34-year-old patient presenting with pushing behind the eye suggesting RH. Once residents made a diagnosis, they practiced performing an emergent LCC on a low-fidelity task trainer supplemented with a novel checklist. The residents completed an assessment questionnaire before and after the teaching module to measure the educational intervention\u27s effectiveness. Results: Learners\u27 scores significantly improved in the ability to recognize and treat RH (12%, Discussion: This educational intervention is a successful resource that can decrease cases of preventable blindness by improving EM residents\u27 ability to recognize and treat RHs

Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

“Trauma to the Eye” – A Low Fidelity Module for Identifying Retrobulbar Hematoma and Practicing Lateral Canthotomy & Cantholysis

Purpose: A retrobulbar hematoma (RH) can cause preventable blindness due to damage of the optic nerve. Due to its relative infrequency in the emergency department, Emergency Medecine (EM) residents have limited experience in recognizing and treating a RH. This paper outlines a simulated scenario that was developed to improve EM residents knowledge in diagnosing a RH and performing an emergent lateral canthotomy and cantholysis (LCC). Methods: This module used a low fidelity task trainer and case vignette created for EM residents to practice recognizing a RH and perfroming a LCC. Participants took an assessment questionnaire before and after the teaching module, which included questions in the knowledge and affective domain. The study measured scores for recognition and treatment of a RH, stress levels (higher scores=less stress), and confidence levels using a paired t-test, and asked participants to indicate their feelings of comparative preparedness after the module. Results and Conclusions: Participants’ scores improved on the assessment questionnaire in the knowledge (12.30%, p=0.00005) and affective (confidence: 17.61%, p=0.0002; stress: 9.64%, p=0.058) domain. All participants indicated that they felt more prepared to treat a RH after the module. The results suggest that this teaching module significantly improved their ability to recognize and treat a RH, their confidence in performing the procedure, and their feelings of relative preparedness, but did not significantly decrease their stress. This module is a successful educational resource that can decrease cases of preventable blindless by improving EM residents ability to recognize and treat RHs