Global Emergency Medicine Fellowships: Survey of Curricula and Pre-Fellowship Experiences

Introduction: Lack of accreditation requirements affords global emergency medicine (GEM) fellowships the flexibility to customize curricula and content. A paucity of literature exists describing the state of GEM fellowship programs. We describe the current state of GEM fellowship curricula including which components are commonly included, and highlighting areas of higher variability.Methods: We identified GEM fellowships and invited them to participate in a web-based survey. Descriptive statistical analysis was performed.Results: Of the 46 fellowship programs invited to participate, 24 responded; one duplicate response and one subspecialty program were excluded. The 22 remaining programs were included in the analysis. Nineteen programs (86%) offer a Masters in Public Health (MPH) and 36% require an MPH to graduate. Additionally, 13 programs (59%) offered graduate degrees other than MPH. Fellows average 61 clinical hours per month (95% confidence interval, 53-68). Time spent overseas varies widely, with the minimum required time ranging from 2-28 weeks (median 8 weeks; interquartile range [IQR] 6,16) over the course of the fellowship. The majority of programs offer courses in tropical medicine (range 2-24 weeks, median 4 weeks) and the Health Emergencies in Large Populations course. Only 32% of programs reported offering formal ultrasound training. Fellows averaged 1.3 research projects prior to fellowship and median of 2.5 during fellowship (IQR 1,3). While the majority of GEM fellowship graduates worked at US academic centers (59%), 24% worked in US community hospitals, 9% worked for non-profit organizations, and 9% worked internationally in clinical practice.Conclusion: Our results highlight the wide variability of curricular content and experiences offered by GEM fellowships

Global Emergency Medicine Fellowships: Survey of Curricula and Pre-Fellowship Experiences

Introduction: Lack of accreditation requirements affords global emergency medicine (GEM) fellowships the flexibility to customize curricula and content. A paucity of literature exists describing the state of GEM fellowship programs. We describe the current state of GEM fellowship curricula including which components are commonly included, and highlighting areas of higher variability.Methods: We identified GEM fellowships and invited them to participate in a web-based survey. Descriptive statistical analysis was performed.Results: Of the 46 fellowship programs invited to participate, 24 responded; one duplicate response and one subspecialty program were excluded. The 22 remaining programs were included in the analysis. Nineteen programs (86%) offer a Masters in Public Health (MPH) and 36% require an MPH to graduate. Additionally, 13 programs (59%) offered graduate degrees other than MPH. Fellows average 61 clinical hours per month (95% confidence interval, 53-68). Time spent overseas varies widely, with the minimum required time ranging from 2-28 weeks (median 8 weeks; interquartile range [IQR] 6,16) over the course of the fellowship. The majority of programs offer courses in tropical medicine (range 2-24 weeks, median 4 weeks) and the Health Emergencies in Large Populations course. Only 32% of programs reported offering formal ultrasound training. Fellows averaged 1.3 research projects prior to fellowship and median of 2.5 during fellowship (IQR 1,3). While the majority of GEM fellowship graduates worked at US academic centers (59%), 24% worked in US community hospitals, 9% worked for non-profit organizations, and 9% worked internationally in clinical practice.Conclusion: Our results highlight the wide variability of curricular content and experiences offered by GEM fellowships

Homemade Cardiac and Vein Cannulation Ultrasound Phantoms for Trauma Management Training in Resource-Limited Settings

Ultrasound has become an essential skill for trauma management in resource-limited areas. Prohibitive costs of commercial ultrasound phantoms limit the abilities of many hospitals to adequately train health-care providers. We assessed the utility of homemade phantoms in a wartime setting. Thirty physicians and technicians enrolled in a medical training course, sponsored by the Syrian American Medical Society (SAMS). Ultrasound simulation models were created onsite by using psyllium, gelatin, a hotel coffee maker, and Pyrex dishes. Lamb hearts were used to teach visual diagnosis and subsequent drainage of pericardial effusions. Penrose drains were used to teach vein identification and cannulation under dynamic ultrasound guidance. Two phantoms with a total of 14 penrose drains were created, serving 30 health-care providers. Feedback from participants was positive and within one month of the course, two cases of pericardial tamponade were diagnosed and surgically treated in the largest trauma hospital operated by SAMS. Context: In resource-limited environments, ultrasound phantoms (models) are cost-prohibitive. Aims: We assessed the utility of homemade phantoms in a resource-limited wartime setting to train Syrian physicians and technicians in vein cannulation and limited cardiac ultrasonography. Settings and Design: Thirty physicians and technicians enrolled in a medical training course, sponsored by SAMS. Methods: Ultrasound simulation models were created onsite by using psyllium, gelatin, a hotel coffee maker, and Pyrex dishes. Lamb hearts were used to teach visual diagnosis and subsequent drainage of pericardial effusions. Penrose drains were used to teach vein identification and cannulation under dynamic ultrasound guidance. Two phantoms with a total of 14 penrose drains were created, serving 30 health-care providers. Statistical Analysis Used: N/A Results: Feedback from participants was positive and within one month of the course, two cases of pericardial tamponade were diagnosed and surgically treated in the largest trauma hospital operated by SAMS. Conclusions: Homemade ultrasound phantoms are a promising cost-effective means for meeting an educational gap in ultrasound training, particularly for resource-limited hospitals and possibly more broadly in residency education

Traumatic Injuries From Sheep Sacrifice During the Eid Al-Adha Holiday: A Prospective Multicentered Study

Objective: We sought to describe injuries related to the sacrificial slaughtering of animals during the Eid holiday. Methods: We conducted a centered prospective observational cohort study during the Eid (August 21-24, 2018) at 5 emergency departments in Gaziantep, Turkey. Descriptive statistics of injuries collected included the injury location, involvement of dominant or non-dominant hand, cause of injury (instrument vs animal), type of instrument causing injury, surgical interventions performed, and professional occupations of patients. Results: We included two hundred seventy-seven patients with injuries who fulfilled the criteria and excluded injuries not related to animal slaughter. Most injuries (91%) occurred in people who were not professional butchers (n=252) and simple laceration (not involving vessels or tendons) was the most common injury type (95.3%; n=265). Those who were injured and had no experience were mostly injured during the processing of the meat (butchering) and while helping others. Lacerations were most commonly observed in the upper extremity (83.4%; n=231), on the non-dominant side (67.5%; n=187), in the hand (78.7%, n=218), and specifically in the index finger (23.1%; n=64). A surgery was performed on 8 patients. Conclusion: The first day of Eid is associated with an increase in mostly non-dominant upper extremity injuries among inexperienced people slaughtering animals. Further education and safety measures may reduce such injuries. Emergency departments serving larger Muslim communities may benefit from anticipating an uptick in these injuries

Workplace violence in emergency departments in Turkey

Background Studies on workplace violence against physicians in emergency departments (EDs) in Turkey are lacking. Methods To describe the frequency and types of workplace violence, a 34-question online survey of the past 12 months was sent to physicians working in EDs in Turkey. Types of violence were categorized as verbal threats, physical assaults, confrontation, stalking, and sexual harassment. Results A total of 366 physicians completed the survey; 4 were excluded (minimum 20 hours/week). Sixty-two percent of respondents were men. Ninety-nine percent reported verbal abuse and 54% reported physical violence. Family members, not patients, were the most common perpetrators of every form of workplace violence. Hospitals limiting the number of visitors and loitering had 14% reduction in physical threats. Only 23% of respondents indicated that their hospital offered information about preventing and managing workplace violence even though 86% noted interest. Only 1% never had fear, even though 89% indicated they had security staff. Over 89% felt that hospital security was lacking in number and ability to protect. For 82%, workplace violence affected their ability to provide patient care. Ninety percent indicated that current laws do not adequately protect them. There was also no statistically significant difference in any type of workplace violence based on the timing or length of shifts, type of hospital, or number of hours worked. Of all types of violence reported, only stalking demonstrated a statistically significant difference between men and women. Conclusion Workplace violence is a real danger for physicians working in EDs in Turkey, similar to other countries, demonstrating that this problem transcends borders. Further studies should assess root causes of violent behaviors of patients and their visitors, as well as possible (administrative, social, and legal) mechanisms to minimize such violence. Hospitals that limited the number of visitors and empowered security officers were associated with decreased violence