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

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

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

“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

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

A Module Based Method of Teaching a Novel Approach to Electrocardiogram Interpretation

Purpose: The traditional approach to 12-lead electrocardiogram interpretation has limitations in the ED setting because it is tedious and does not emphasize pattern recognition for potentially fatal conditions that ED physicians must recognize. Additionally, while lecture-based learning is necessary, learning modules can help learners gain a better understanding of the material. The purpose of this study was to create and implement a self-paced learning module that teaches a novel way of ECG interpretation through the following steps: is it sinus? is it wide? is there ischemia? and does this herald sudden death? Methods: The objective endpoint of this study was to determine if the novel method of interpretation increases accuracy and efficiency of ECG interpretation in ED residents. Pre and post module ECG interpretation tests were used to determine the efficacy of the module. The subjective endpoint was to determine if learners were satisfied with the novel approach and the module-based learning style which was achieved by surveys. Results and Conclusion: The online learning module was shown to significantly increase accuracy of ECG interpretation. The post-test data showed there was a 21.8% increase in the median percent correct after the module (t= 5.48, p \u3c 0.0001). The surveys demonstrated that after the module residents incorporated the novel approach and would use the module as a resource in the future. This study adds to the body of evidence that a novel approach and learning modules can be an effective tool for EM resident education

Reversible Cerebral Vasoconstriction Disorder in a Patient with a Chief Complaint of Headache.

As emergency medicine physicians, we have formulated an approach to managing patients with a chief complaint of headache that starts with considering the story the patient relays in the context of a wide differential. Here we will describe a case that presented to our emergency department in hopes to broaden your differential. Reversible cerebral vasoconstriction syndrome (RCVS), well described in the neurology literature, is characterized by severe headaches that may or may not be accompanied by neurological symptoms and is definitively diagnosed by diffuse constriction of cerebral arteries on cerebral angiogram. Here we present a case of a patient who presented to the emergency department with intermittent severe persistant headaches and was diagnosed with reversible cerebral vasoconstriction syndrome

Gamification of Hospital Utilization: Incorporating Cost-consciousness in Daily Practices.

Healthcare costs in the United States have skyrocketed over the past decade, contributing to an estimated $750 billion in wasteful spending annually. Despite the demand to improve residency education on value-based, cost-conscious healthcare, there is no consensus on how to best teach this practice. Traditional lectures have failed to demonstrate enduring change in clinical practice patterns, provider attitudes, and reductions in hospital expenditures. We sought to evaluate whether gamification is an effective pedagogical tool to teach cost-consciousness to emergency medicine (EM) residents by creating a 60-minute interactive session based on the popular gameshow, the Price is Right. Costs and associated charges for common laboratory tests, radiographic studies, medications, and common physical resources typically found in the emergency department (ED) were first obtained through direct communication with the ED clinical director and hospital leadership. The session itself consisted of three phases with several Price-is-Right-themed games, which included realistic visual stimuli reminiscent of the gameshow that were created by the authors using the PowerPoint. Formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the educational intervention was obtained through a 22-item questionnaire using a five-point Likert-type scale from 19 of the 22 enrolled residents (86% response rate). Responses were generally very positive with an overall course rating score of 4.16 (SD +/- 0.90). Qualitative feedback identified learners\u27 predilection for gamified delivery of nonclinical content during conference. The majority of residents (89%) recommend the activity to be used in subsequent offerings to other learners. With healthcare costs on the rise, our feasibility study demonstrated that gamification is an effective way to teach mindful, cost-conscious care to EM residents. Gamification offers a fun and engaging alternative that should be further utilized in EM educational formats. Future studies are needed to longitudinally assess the learner retention and cost-containment practices

The Clicker Study

Purpose: A recent study in orthopedics showed that clicker-based learning was more effective than traditional feedback when teaching procedures. We sought to determine whether this principle is applicable to ultrasound skills. Methods: Our prospective randomized control trial used a population of new ultrasound learners. Exclusion criteria included previous ultrasound experience of more than one hour. Students were shown an instructional video on the Focused Assessment with Sonography in Trauma (FAST) exam and randomized to receive clicker or scripted feedback. Each student performed the FAST exam once without feedback, then with either scripted or clicker-based feedback. They were timed and scored on 18 microskills. Results and Conclusions: 45 students were enrolled in the study, with 6 excluded from analysis. This included 24 premedical and 15 medical students. No significant differences were observed between groups for time or accuracy on the FAST exam. Among medical students, there was a trend toward faster results in the clicker group (mean=83 seconds) than the script group (mean=103 seconds) (p=0.22). Among undergraduates, there was a trend toward higher accuracy in the script group (mean=100%) than the clicker group (mean=95%) (p=0.068) and towards faster performance (mean=103 seconds) than the clicker group (mean=121 seconds) (p=0.38). Although no significant differences were observed, there seemed to be a trend toward faster performance with clicker feedback among medical students and faster and more accurate performance with scripted feedback among premedical students. This may be an area for future study