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Hoxha I, Hekman DJ, Schnapp B. Second- and third-year medical students' clinical encounters in the emergency department. AEM EDUCATION AND TRAINING 2024; 8:e10937. [PMID: 38504802 PMCID: PMC10950016 DOI: 10.1002/aet2.10937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/08/2023] [Accepted: 11/23/2023] [Indexed: 03/21/2024]
Abstract
Background Experiential learning theory suggests that direct clinical experiences facilitate learning. Previous literature has focused primarily on the experiences of fourth-year medical students. As more students gain early clinical exposure, it is important to understand the types of patients seen by junior students. Objectives This study aims to categorize the clinical experiences of early (M2 and M3) students in the emergency department (ED). Methods A retrospective review of the electronic health record of patients seen by M2s and M3s on a 2-week emergency medicine rotation at a single urban academic ED in the Midwest was performed. Data elements extracted included total number of patients seen, Emergency Severity Index (ESI), disposition, and chief complaint. Students were not mandated to see any particular patients. Results Medical students (248) saw 2994 total patients from 2018 to 2022. The median number of patients seen by each student was 12.0 (range 1-32). Pediatric patients made up 6.5% (n = 194) of total patients. Encounters were primarily ESI 2 or 3, which accounted for 89.4% of all patients (n = 2676). The most encountered complaints were abdominal pain, chest pain, and dyspnea, making up 15.6% (n = 467), 8.7% (n = 260), and 5.5% (n = 165), respectively, of total cases. Obstetrics/gynecology, hematologic, and environmental disorders were the least frequently encountered domains. No students saw all Clerkship Directors in Emergency Medicine (CDEM)-recommended complaints. Conclusions There is significant variability in the ED encounters of M2s and M3s, with wide ranges of patient volume and presentations. This study provides some evidence that early students may not be meeting CDEM recommendations.
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Affiliation(s)
- Ines Hoxha
- University of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Daniel J. Hekman
- Department of Emergency MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Benjamin Schnapp
- Department of Emergency MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
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Chang YC, Nkambule NS, Chen SY, Hsieh MJ, Chaou CH. Exploring the Impact of Pre-course High-Fidelity Simulation on Professional Socialization of Medical Students in Emergency Medicine Internship Rotation—A Qualitative Approach. Front Med (Lausanne) 2022; 9:933212. [PMID: 35847773 PMCID: PMC9280693 DOI: 10.3389/fmed.2022.933212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Medical students in block clerkships constantly adapt to new environments and learn to interact with new people as they rotate between specialties. This frequent change potentially limited interns' opportunities for participation in real clinical practice. The aims of this study were to explore interns' conceptualization of their learning opportunities and experiences in the workplace during an emergency medicine (EM) block internship. In addition, the study also explored how participating in the pre-rotation high-fidelity simulation (HFS) orientation influenced interns' perception of their transition, participation and learning experiences in the real EM setting. Methods We implemented a newly developed pre-EM rotation orientation curriculum for interns. This orientation took place on the first day of the 2-week EM internship rotation. Two focus group discussions were held after each simulation training, one immediately after simulation to understand the students' perception and the educational impact of this activity, the other at the end of EM rotation to explore and compare their roles and perception in both simulation activity and the real clinical practice. A total of 151 seventh-year medical students enrolled in the pre-course HFS and post-hoc focus group discussions between 2017 and 2019. We applied thematic analysis to systemically identify, examine, and construct themes. Results Four major themes were constructed from the data; 1. Challenges in finding authentic learning experiences within the context of emergency medicine; 2. Effectiveness of the pre-course HFS 3. Limitations of EM internship rotation curriculum and pre-course simulation. 4. Suggestions for EM block-internship curriculum reforms. Our study's key findings indicate that pre-rotation orientation HFS activity, which offered a psychologically safe space for students to explore facets of EM and gain a contextualized understanding of the emergency work culture and environment, was essential for enhancing students' ability to identify and maximize practice affordances in real workplace. Conclusion Simulation, facilitates interns' negotiation of legitimate peripheral participation opportunities as they transition into the EM community of practice during their block internship rotation; putting students at the center of the learning process.
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Affiliation(s)
- Yu-Che Chang
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nothando Sithulile Nkambule
- International Graduate Program of Education and Human Development, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chung-Hsien Chaou
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Rosenthal HB, Sikka N, Lieber AC, Sanky C, Cayon C, Newman D, Marquez DR, Ziff J, Blum JR, Dai JB, Groden P, Pasik S, Pour T. A Near-Peer Educational Model for Online, Interactive Learning in Emergency Medicine. West J Emerg Med 2020; 22:130-135. [PMID: 33439819 PMCID: PMC7806329 DOI: 10.5811/westjem.2020.12.49101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/14/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The COVID-19 pandemic led to a large disruption in the clinical education of medical students, particularly in-person clinical activities. To address the resulting challenges faced by students interested in emergency medicine (EM), we proposed and held a peer-led, online learning course for rising fourth-year medical students. Methods A total of 61 medical students participated in an eight-lecture EM course. Students were evaluated through pre- and post-course assessments designed to ascertain perceived comfort with learning objectives and overall course feedback. Pre- and post-lecture assignments were also used to increase student learning. Results Mean confidence improved in every learning objective after the course. Favored participation methods were three-person call-outs, polling, and using the “chat” function. Resident participation was valued for “real-life” examples and clinical pearls. Conclusion This interactive model for online EM education can be an effective format for dissemination when in-person education may not be available.
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Affiliation(s)
- Hailey B Rosenthal
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Neha Sikka
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Adam C Lieber
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Charles Sanky
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Christian Cayon
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Daniel Newman
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Denisse R Marquez
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Jacob Ziff
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - James R Blum
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Jennifer B Dai
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Phillip Groden
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Sara Pasik
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Trevor Pour
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
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Development of an Undergraduate Medical Education Critical Care Content Outline Utilizing the Delphi Method. Crit Care Med 2020; 48:98-103. [PMID: 31714399 DOI: 10.1097/ccm.0000000000004086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline. DESIGN The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline. SETTING An electronic survey of critical care medical educators, residency program directors, and residents in the United States. SUBJECTS The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended. CONCLUSIONS This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.
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Berger-Estilita J, Nabecker S, Greif R. A Delphi consensus study for teaching "Basic Trauma Management" to third-year medical students. Scand J Trauma Resusc Emerg Med 2019; 27:91. [PMID: 31623634 PMCID: PMC6798469 DOI: 10.1186/s13049-019-0675-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background The Basic-Trauma Management (BTM) course has been taught to third-year medical students in small groups for many years without substantial changes. With the introduction of a new curriculum for Swiss medical students, it was necessary to revise the BTM content and re-align it. Our aim was to identify core competencies for the revised BTM course. Methods We applied a three-round step-wise Delphi consensus. First, we asked open-ended questions on what were the most important competencies to be taught for BTM; the second round used Likert scales to ensure agreement on the competencies; and the final round reached out for consensus on these BTM competencies. Stakeholders were selected based on their long-standing experience in teaching BTM and in managing trauma patients. Results Consensus was found on 29 competencies out of an initial 130 proposals. “Human Factors”, which had not been taught previously, scored relatively high, at 22%. The sole specific trauma skill agreed upon was the use of tourniquets. Conclusions This is an example of curricular revision of a clinical skills course after the introduction of a regulatory framework for undergraduate medical education. The revised course curriculum tailors the concepts and skills in trauma that fulfill stakeholder needs, and are in agreement with the new Swiss learning outcomes.
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Affiliation(s)
- Joana Berger-Estilita
- Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, Freiburgstrasse 8-10, 8010, Bern, Switzerland.
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, Freiburgstrasse 8-10, 8010, Bern, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, Freiburgstrasse 8-10, 8010, Bern, Switzerland
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Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship. Int J Radiat Oncol Biol Phys 2018; 101:1039-1045. [PMID: 29908787 DOI: 10.1016/j.ijrobp.2018.04.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment. METHODS AND MATERIALS Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum. RESULTS One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11). CONCLUSIONS Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.
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Jung J, Franzen D, Lawson L, Manthey D, Tews M, Dubosh N, Fisher J, Haughey M, House JB, Trainor A, Wald DA, Hiller K. The National Clinical Assessment Tool for Medical Students in the Emergency Department (NCAT-EM). West J Emerg Med 2017; 19:66-74. [PMID: 29383058 PMCID: PMC5785203 DOI: 10.5811/westjem.2017.10.34834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variable process that presents unique challenges and opportunities. Currently, clerkship directors use institution-specific tools with unproven validity and reliability that may or may not address competencies valued most highly in the EM setting. Standardization of assessment practices and development of a common, valid, specialty-specific tool would benefit EM educators and students. Methods A two-day national consensus conference was held in March 2016 in the Clerkship Directors in Emergency Medicine (CDEM) track at the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly in Nashville, TN. The goal of this conference was to standardize assessment practices and to create a national clinical assessment tool for use in EM clerkships across the country. Conference leaders synthesized the literature, articulated major themes and questions pertinent to clinical assessment of students in EM, clarified the issues, and outlined the consensus-building process prior to consensus-building activities. Results The first day of the conference was dedicated to developing consensus on these key themes in clinical assessment. The second day of the conference was dedicated to discussing and voting on proposed domains to be included in the national clinical assessment tool. A modified Delphi process was initiated after the conference to reconcile questions and items that did not reach an a priori level of consensus. Conclusion The final tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM) is presented here.
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Affiliation(s)
- Julianna Jung
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland
| | - Douglas Franzen
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Luan Lawson
- East Carolina University, Department of Emergency Medicine, Greenville, North Carolina
| | - David Manthey
- Wake Forest University, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Matthew Tews
- Medical College of Georgia, Department of Emergency Medicine, Augusta, Georgia
| | - Nicole Dubosh
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jonathan Fisher
- University of Arizona, Phoenix, Department of Emergency Medicine, Phoenix, Arizona
| | - Marianne Haughey
- City University of New York, Department of Emergency Medicine, New York, New York
| | - Joseph B House
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Arleigh Trainor
- University of South Dakota, Department of Emergency Medicine, Vermillion, South Dakota
| | - David A Wald
- Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Katherine Hiller
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
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8
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Oskvarek JJ, Brower JV, Mohindra P, Raleigh DR, Chmura SJ, Golden DW. Educational Impact of a Structured Radiation Oncology Clerkship Curriculum: An Interinstitutional Comparison. J Am Coll Radiol 2017; 14:96-102. [PMID: 27652570 PMCID: PMC5222702 DOI: 10.1016/j.jacr.2016.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 05/29/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Many medical school clerkships have structured curricula; however, most radiation oncology clerkships do not. The Radiation Oncology Education Collaborative Study Group (ROECSG) implemented a curriculum for fourth-year radiation oncology clerkships at 14 institutions. We hypothesized that students completing clerkships with the curriculum would report greater subjective knowledge and comfort to function as a radiation oncology resident compared with students completing clerkships without the curriculum. METHODS The ROECSG curriculum included three 1-hour lectures and a 1-hour hands-on radiation treatment planning workshop. Applicants to a single radiation oncology residency program in the 2014-2015 academic year were sent an anonymous, validated clerkship experience survey. Students indicated if clerkships were completed at a curriculum site. Likert-type data (1 = not at all, 5 = extremely) are reported as median (interquartile range). RESULTS Respondents described 276 clerkship experiences, of which 64 (23.2%) were completed at a curriculum site. Students whose first clerkship was at a curriculum site perceived greater postclerkship confidence in knowledge of radiation biology (3 [3-4] versus 2 [2-3], P < .01), treatment setup/positioning (3 [2-3] versus 2 [2-3], P < .05), treatment planning (3 [2-3] versus 2 [2-3], P < .01), and ability to integrate evidence-based medicine into treatment (4 [2-4] versus 3 [2-4], P < .05). Students who completed any clerkship with the curriculum had greater postclerkship confidence to function as a radiation oncology resident (3 [3-4] versus 3 [2-3], P < .05). CONCLUSIONS These results support the curriculum's ability to increase student knowledge in radiation oncology, especially in the students' first clerkship. Further, these findings suggest that expanded implementation of such curricula may ensure a rewarding educational experience during radiation oncology clerkships.
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Affiliation(s)
| | - Jeffrey V Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - David R Raleigh
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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Hiller KM, Franzen D, Lawson L, Manthey D, Fisher J, Haughey M, Tews M, Dubosh N, House J, Trainor A, Wald D, Jung J. Clinical Assessment of Medical Students in the Emergency Department, a National Consensus Conference. West J Emerg Med 2016; 18:82-83. [PMID: 28116013 PMCID: PMC5226769 DOI: 10.5811/westjem.2016.11.32686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katherine M Hiller
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Douglas Franzen
- University of Washington, Department of Medicine, Division of Emergency Medicine, Seattle, Washington
| | - Luan Lawson
- East Carolina University, Department of Emergency Medicine, Greenville, North Carolina
| | - David Manthey
- Wake Forest University, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Jonathan Fisher
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Marianne Haughey
- St. Barnabas Medical Center, Department of Emergency Medicine, Bronx, New York
| | - Matthew Tews
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
| | - Nicole Dubosh
- Harvard University, Department of Emergency Medicine, Cambridge, Massachusetts
| | - Joseph House
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Arleigh Trainor
- University of South Dakota, Department of Emergency Medicine, Vermillion, South Dakota
| | - David Wald
- Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Julianna Jung
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland
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