Self-Reported Emergency Medicine Residency Applicant Attitudes Towards a Procedural Cadaver Laboratory Curriculum

Objective: Residency applicants consider a variety of factors when ranking emergency medicine (EM) programs for their NRMP match list. A human cadaver emergency procedure lab curriculum is uncommon. We hypothesized that the presence this curriculum would positively impact the ranking of an EM residency program.Methods: The EM residency at Nebraska Medical Center is an urban, university-based program with a PGY I-III format. Residency applicants during the interview for a position in the PGY I class of 2006 were surveyed by three weekly electronic mailings. The survey was distributed in March 2006 after the final NRMP match results were released. The survey explored learner preferences and methodological commonality of models of emergency procedural training, as well as the impact of a procedural cadaver lab curriculum on residency ranking. ANOVA of ranks was used to compare responses to ranking questions.Results: Of the 73 potential subjects, 54 (74%) completed the survey. Respondents ranked methods of procedural instruction from 1 (most preferred or most common technique) to 4 (least preferred or least common technique). Response averages and 95% confidence intervals for the preferred means of learning a new procedure are as follows: textbook (3.69; 3.51-3.87), mannequin (2.83; 2.64-3.02), human cadaver (1.93; 1.72-2.14), and living patient (1.56; 1.33-1.79). Response averages for the commonality of means used to teach a new procedure are as follows: human cadaver (3.63; 3.46-3.80), mannequin (2.70; 2.50-2.90), living patient (2.09; 1.85-2.33), and textbook (1.57; 1.32-1.82). When asked if the University of Nebraska Medical Center residency ranked higher in the individual’s match list because of its procedural cadaver lab, 14.8% strongly disagreed, 14.8% disagreed, 40.7% were neutral, 14.8% agreed, and 14.8% strongly agreed.Conclusion: We conclude that, although cadaveric procedural training is viewed by senior medical student learners as a desirable means of learning a procedure, its use is uncommon during medical school, and its presence as part of a residency curriculum does not influence ranking of the residency program.[WestJEM. 2008;9:141-145.

Task analysis method for procedural training curriculum development

A central venous catheter (CVC) is an important medical tool used in critical care and emergent situations. Integral to proper care in many circumstances, insertion of a CVC introduces the risk of central line-associated blood stream infections and mechanical adverse events; proper training is important for safe CVC insertion. Cognitive task analysis (CTA) methods have been successfully implemented in the medical field to improve the training of postgraduate medical trainees, but can be very time-consuming to complete and require a significant time commitment from many subject matter experts (SMEs). Many medical procedures such as CVC insertion are linear processes with well-documented procedural steps. These linear procedures may not require a traditional CTA to gather the information necessary to create a training curriculum. Accordingly, a novel, streamlined CTA method designed primarily to collect cognitive cues for linear procedures was developed to be used by medical professionals with minimal CTA training. This new CTA methodology required fewer trained personnel, fewer interview sessions, and less time commitment from SMEs than a traditional CTA. Based on this study, a streamlined CTA methodology can be used to efficiently gather cognitive information on linear medical procedures for the creation of resident training curricula and procedural skills assessments

Long-Term Assessment of the Effects of COVID-19 and Isolation Care on Survivor Disability and Anxiety

We conducted an assessment of disability, anxiety, and other life impacts of COVID-19 and isolation care in a unique cohort of individuals. These included both community admissions to a university hospital as well as some of the earliest international aeromedical evacuees. Among an initial 16 COVID-19 survivors that were interviewed 6-12 months following their admission into isolation care, perception of their isolation care experience was related to their reporting of long-term consequences. However, anxiety and disability assessed with standard scores had no relationship with each other. Both capture of the isolation care experience and caution relying on single scoring systems for assessing long-term consequences in survivors are important considerations for on-going and future COVID-19 and other pandemic survivor research

The 2016 Model of The Clinical Practice of Emergency Medicine

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, “The Model of the Clinical Practice of Emergency Medicine” (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents\u27 Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (1). The resulting product was first published in 2001, and has successfully served as the common source document for all EM organizations (2,3). One of its strengths is incorporating the reality that EM is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions

Assessment of a Brief Handoff Skills Workshop for Incoming Interns: Do past Handoff Experiences Impact Training Outcomes?

Background Patient care handoffs are a core professional activity that incoming interns are expected to perform without direct supervision upon starting residency, yet training in medical schools is inconsistent. Objective To implement a brief handoff communication workshop for incoming interns and determine whether learner-level determinants were associated with differences in training outcomes. Methods We conducted a one-hour interactive handoff skills workshop for all incoming interns at a Midwestern academic medical center. We performed paired pre/post-intervention assessments of participants' attitudes and ability to perform representative handoff skills. The results were analyzed in aggregate and based upon participants' prior handoff experiences using Wilcoxon signed-rank test. Results Ninety-nine of 108 interns (91.7%) completed both pre- and post-surveys. There was significant improvement in all 10 attitude-based questions ( P ≤ 0.014 for all) and on the skills assessment (1.07 vs 2.16 on 0–4 point scale, SD 1.25, P ≤ 0.001). Results remained significant regardless of prior training, number of handoffs observed, number of handoffs performed, medical school, or residency discipline. Conclusion A brief interactive workshop for incoming interns can improve participants' confidence and performance of basic handoff skills, regardless of previous training or experience

Assessment of a Chief Complaint–Based Curriculum for Resident Education in Geriatric Emergency Medicine

Introduction: We hypothesized that a geriatric chief complaint–based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED).Methods: A geriatric chief complaint curriculum addressing the 3 most common chief complaints—abdominal pain, weakness, and falls—was developed and presented. A pre- and postcurriculum implementation chart review assessed resident documentation of the 5 components of geriatric ED care: 1) differential diagnosis/patient evaluation considering atypical presentations, 2) determination of baseline function, 3) chronic care facility/caregiver communication, 4) cognitive assessment, and 5) assessment of polypharmacy. A single reviewer assessed 5 pre- and 5 postimplementation charts for each of 18 residents included in the study. We calculated 95% confidence and determined that statistical significance was determined by a 2-tailed z test for 2 proportions, with statistical significance at 0.003 by Bonferroni correction.Results: For falls, resident documentation improved significantly for 1 of 5 measures. For abdominal pain, 2 of 5 components improved. For weakness, 3 of 5 components improved.Conclusion: A geriatric chief complaint–based curriculum improved emergency medicine resident documentation for the care of elderly patients in the ED compared with a non–age-specific chief complaint–based curriculum. [West J Emerg Med. 2011;12(4):484–488.