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Fults E, Gerwin JN, Boyce MW, Joseph M, Wong AH, Evans LV. Educational and personal impacts of the COVID-19 pandemic on emergency medicine resident physicians: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:1055. [PMID: 39334215 PMCID: PMC11429862 DOI: 10.1186/s12909-024-05972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND The COVID-19 pandemic had a significant impact on both the clinical practice and the psychological states of frontline physicians in the emergency department. Trainees, at the beginning of their careers and thus still developing their practice styles and identities as physicians, were uniquely affected. OBJECTIVE In this qualitative study, we sought to explore how the pandemic environment shaped the experiences of emergency medicine resident physicians. METHODS This was a qualitative study. We conducted in-depth interviews with emergency medicine faculty, resident physicians, and staff at a single emergency department based at an urban academic institution in the northeastern United States. Interviews were audio recorded and transcribed, and transcripts were then analyzed in an iterative process by our coding team for recurring themes related to the resident experience. RESULTS We reached data saturation with 27 individuals. Of those who were interviewed, 10 were resident physicians [6 senior residents (PGY-3 or PGY-4) and 4 junior residents (PGY-1 or PGY-2)]. Three major recurring themes regarding resident physician experience emerged during our analysis of the interviews: (1) novel educational experiences dampened by negative structural forces from the pandemic, (2) fracturing of social interactions and mitigation through ad-hoc support systems and community of practice, and (3) development of negative emotions and psychological trauma including fear, resentment, and moral injury causing lasting harm. CONCLUSIONS Our results suggest that emergency medicine resident physicians training during the COVID-19 pandemic faced unique experiences concerning their education, social support systems, and emotional states. While the educational and social experiences were described as having both negative and positive impacts, the emotional experiences were largely negative. Residency program leadership may use these insights to improve resident preparation, wellness, and resilience in the face of future adverse events.
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Affiliation(s)
- Elyse Fults
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey N Gerwin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael W Boyce
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Leigh V Evans
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
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Hrdy M, Faig W, Ren D, Lee B, Tay KY, Guttadauria B, Zaveri P, Lavoie M, Zhao X. A Comparison of Telesimulation Using the Virtual Resus Room and In Situ Simulation in Pediatric Emergency Medicine. Pediatr Emerg Care 2024:00006565-990000000-00515. [PMID: 39180191 DOI: 10.1097/pec.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
OBJECTIVES During the COVID-19 pandemic, there was a marked shift toward telesimulation in medical education. Limited studies exist comparing the effectiveness of online and offline simulation education. The goals of this study are to evaluate active learners' perceived effectiveness of telesimulation versus in situ simulation and to identify potential shortcomings of existing online teaching platforms. METHODS Through participant evaluations after a simulation, we compared telesimulation using the Virtual Resus Room (VRR) to in situ simulation in the domains of (1) self-efficacy, (2) fidelity, (3) educational value, and (4) teaching quality. Study subjects included medical and pharmacy residents and medical students completing their pediatric emergency medicine rotation at two children's hospitals as well as nurses, nurse practitioners, and physician assistants who were recently hired and orienting to their new roles in the emergency department. Learners used a modified Michigan Standard Simulation Experience Scale to evaluate either a telesimulation or in situ simulation case. Survey responses were compared using Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. RESULTS In overall assessment, in situ simulation was rated higher than telesimulation. There were significant differences noted related to perceived realism, utility in training device-related skills, and utility in training team-building skills. All P values were less than 0.0036. There were no significant differences between simulation types in perception of physical examination fidelity, instructor adequacy, or self-efficacy. CONCLUSIONS Telesimulation using the VRR is comparable to in situ simulation in learners' perception of improvement in self-efficacy and of teaching quality for pediatric emergency medicine topics. However, participants felt less able to practice tactile and communication skills virtually. Further innovation is needed to improve learners' experience with fidelity and educational value.
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Affiliation(s)
| | - Walter Faig
- Children's Hospital of Philadelphia, Philadelphia, PA
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Coelho DL, Amaral RC, Silva IC, Oliveira AVOB, Neto AS, Silva JFP, Joviano-Santos JV. Realistic simulation and medical students' performance in the Advanced Cardiac Life Support course: a comparative study. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:61-68. [PMID: 37994405 DOI: 10.1152/advan.00113.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Clinical practice has benefited from new methodologies such as realistic simulation (RS). RS involves recreating lifelike scenarios to more accurately reflect real clinical practice, enhancing learners' skills and decision-making within controlled environments, and experiencing remarkable growth in medical education. However, RS requires substantial financial investments and infrastructure. Hence, it is essential to determine the effectiveness of RS in the development of skills among medical students, which will improve the allocation of resources while optimizing learning. This cross-sectional study was carried out in the simulation laboratory of a medical school, and the performance of students who underwent two different curriculum matrices (without RS and with RS, from 2021 to 2022) in the Advanced Cardiac Life Support (ACLS) course was compared. This test was chosen considering that the competencies involved in cardiac life support are essential, regardless of the medical specialty, and that ACLS is a set of life-saving protocols used worldwide. We observed that the impact of RS can be different for practical abilities when compared with the theoretical ones. There was no correlation between the general academic performance and students' grades reflecting the RS impact. We conclude that RS leads to less remediation and increased competence in practical skills. RS is an important learning strategy that allows repeating, reviewing, and discussing clinical practices without exposing the patient to risks.NEW & NOTEWORTHY Realistic simulation (RS) positively affected the performance of the students differently; it had more influence on practical abilities than theoretical knowledge. No correlation between the general academic performance and grades of the students without RS or with RS was found, providing evidence that RS is an important tool in Advanced Cardiac Life Support education.
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Affiliation(s)
- Débora L Coelho
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosana C Amaral
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella C Silva
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Virgínia O B Oliveira
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Scalabrini Neto
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Felippe P Silva
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julliane V Joviano-Santos
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Investigações NeuroCardíacas, Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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McMains JC, Larkins MC, Doherty AM, Horiates J, Alachraf K, Gordon JA, Fletcher J, Brewer KL. Knowledge Retention From Emergency Medicine Simulation-Based Learning Curriculum for Pre-clinical Medical Students. Cureus 2023; 15:e41216. [PMID: 37525818 PMCID: PMC10387342 DOI: 10.7759/cureus.41216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Introduction Traditional medical school curricula rely on textbook-based learning during the first two years, often limiting students' clinical exposure. Simulation-based learning (SBL) provides an opportunity for students to gain clinical exposure and competency with common procedures as well as to gain knowledge related to common clinical topics. Retention of factual knowledge is a current topic of discussion as medical learners often have difficulty with long-term retention. The aim of this study was to assess if students would learn, retain, and enjoy emergency medicine (EM)-focused SBL. Materials and methods We developed an EM-focused SBL curriculum consisting of four main educational events: suturing, medical stabilization, mass casualty triage, and point-of-care ultrasound (POCUS). Participants were first- and second-year healthcare students enrolled in a traditional, preclinical curriculum, who completed pre- and post-event quizzes consisting of multiple-choice questions on topics covered during the SBL scenario. We compared pre- and post-event quiz scores using a one-way paired t-test. Quizzes were readministered up to 100 days after each SBL event to test knowledge retention, and scores were compared across time by repeated-measures analysis of variance (RMANOVA). Results For suture (n=22), mass casualty (n=20), and ultrasound simulations (n=17), post-event mean quiz scores increased significantly in comparison to mean quiz scores from before the event (p≤0.05). Medical stabilization simulation post-event scores were increased but did not reach statistical significance. Data collected at 45, 74, and 94 days following the suture lab as well as 29 and 49 days after the medical evacuation event, and 20 days after the mass casualty event showed no statistical decrease in quiz means suggesting retention of knowledge among learners. Subjective assessments of participant satisfaction demonstrated an enjoyment of the events. Discussion EM-focused SBL events offered enjoyable learning opportunities for students to effectively obtain and possibly retain clinical knowledge. Conclusion SBL has the potential to improve student retention of clinical knowledge during the preclinical years and, therefore, should be further explored and implemented as a core pillar of medical education as opposed to its current state as a learning adjunct.
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Affiliation(s)
- Jennifer C McMains
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Michael C Larkins
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Alexandra M Doherty
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Julia Horiates
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Kamel Alachraf
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Julian A Gordon
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - James Fletcher
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
| | - Kori L Brewer
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, USA
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Sperandeo M, Moadel T, Yun S, Pollack S, Cassara M. Novel, Synchronous, First-person Perspective Virtual Simulations for Medical Students in Emergency Medicine. West J Emerg Med 2023; 24:68-70. [PMID: 36735004 PMCID: PMC9897239 DOI: 10.5811/westjem.2022.11.57764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Michael Sperandeo
- Long Island Jewish Medical Center, Department of Emergency Medicine, New Hyde Park, New York,Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Tiffany Moadel
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York,North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Sezzy Yun
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York
| | - Stephanie Pollack
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York,North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Michael Cassara
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
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Chaffkin J, Ray JM, Goldenberg M, Wong AH. Impact of a Virtual Simulation-Based Educational Module on Managing Agitation for Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:495-499. [PMID: 34505279 PMCID: PMC8428505 DOI: 10.1007/s40596-021-01521-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/02/2021] [Indexed: 05/06/2023]
Affiliation(s)
| | - Jessica M Ray
- Yale University School of Medicine, New Haven, CT, USA
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Shirani F. Integrating diversity in simulation-based education: Potential role of virtual reality. AEM EDUCATION AND TRAINING 2021; 5:e10608. [PMID: 34222748 PMCID: PMC8194318 DOI: 10.1002/aet2.10608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Farzaneh Shirani
- Department of Emergency MedicineTehran University of Medical SciencesTehranIran
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Offenbacher J, Petti A, Xu H, Levine M, Manyapu M, Guha D, Quint M, Chertoff A, Restivo A, Friedman BW, Silverberg J. Learning Outcomes of High-fidelity versus Table-Top Simulation in Undergraduate Emergency Medicine Education: Prospective, Randomized, Crossover-Controlled Study. West J Emerg Med 2021; 23:20-25. [PMID: 35060855 PMCID: PMC8782127 DOI: 10.5811/westjem.2021.12.53926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/04/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Over the last several decades simulation, in both graduate and undergraduate emergency medicine education, has continued to develop as a leading and highly effective teaching modality. Limited research exists to evaluate the efficacy of low-fidelity (table-top) simulation, as compared to high-fidelity standards, as it relates to medical knowledge learning outcomes. We sought to assess the efficacy of a low-fidelity simulation modality in undergraduate emergency medicine education, based on quantitative medical knowledge learning outcomes. METHODS A prospective, randomized, crossover-control study comparing objective medical knowledge learning outcomes between simulation modalities. Analysis was designed to evaluate for the statistical equivalence of learning outcomes between the two cohorts. This was done by comparing a calculated 95% confidence interval (CI) around the mean difference in post-test scores, between experimental and control modalities, to a pre-established equivalence margin. RESULTS Primary outcomes evaluating student performance on post-test examinations demonstrated a total cohort CI (95% CI, -0.22 and 0.68). Additional course-subject subgroup analysis demonstrated non-inferior CIs with: Shortness of Breath (95% CI, -0.35 and 1.27); Chest Pain (95% CI, -0.53 and.94); Abdominal Pain (95% CI, -0.88 and 1.17); Cardiovascular Shock (95% CI, -0.04 and 1.29). Secondary outcome analysis was done to evaluate medical knowledge acquisition by comparing the difference in pre and post-test examination between the cohorts. CI of the full cohort ranged from (95% CI, -0.14 and 0.96). CONCLUSION The student's performance on quantitative medical-knowledge assessment was equivalent between the high-fidelity control and low-fidelity experimental simulation groups. Analysis of knowledge acquisition between the two groups also demonstrated statistical equivalence.
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Affiliation(s)
- Joseph Offenbacher
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Alexander Petti
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Han Xu
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Michael Levine
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Mallika Manyapu
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Debayan Guha
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Maxim Quint
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Andrew Chertoff
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Andrew Restivo
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Benjamin W Friedman
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
| | - Joshua Silverberg
- Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Hospitals, Bronx, New York
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