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Davis M, Okoli D, House J, Santen S. Are interns prepared? A summary of current transition to residency preparation courses content. AEM EDUCATION AND TRAINING 2024; 8:e11015. [PMID: 39193051 PMCID: PMC11349451 DOI: 10.1002/aet2.11015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/16/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
Background The transition from medical student to emergency medicine resident is a critical point in training. Medical students start residency with different levels of understanding and some are not meeting the emergency medicine (EM) Level 1 milestones. Residency preparation courses (RPCs) were created to fill this gap and prepare medical students for residency. Objectives The objective was to review content from current RPC curricula to determine the content that should be included in an EM-specific transition to residency preparation course. Methods We collected curricula from RPC course directors at different institutions and reviewed and coded the topics into categories: (1) didactics, (2) procedures, and (3) unique topics (defined as nontraditional topics that did not fit squarely into didactics or procedures). Results We obtained content from 13 different RPC curricula. Length of the courses ranged from one to 8 weeks with the mean being three weeks. Most courses were taught within a larger medical school course and were not specific to EM (62%). The most frequently taught didactic topics were airway interventions (85%), critical care (69%), and chest pain/shortness of breath (62%). Most programs included a simulation component (92%) and the most common procedures included airway interventions (69%); lines-central, arterial, and Cordis (69%); lumbar puncture (62%); and ultrasound (62%). Many of the courses had unique or special features taught within the curriculum. The most frequently taught unique content were sessions on self-awareness and self-regulation (85%) and advanced communication (69%). Conclusions After multiple RPC curricula content was reviewed, a set of basic curriculum has been determined and supported by the content analysis. By including a standardized curriculum within RPC's, this will help better prepare medical students and create a standard for medical students entering EM residency and may allow intern orientations to focus on higher level skills.
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Affiliation(s)
- Mallory Davis
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Donna Okoli
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Joseph House
- Department of Emergency Medicine and PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Sally Santen
- Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Nikolla DA, Offenbacher J, April MD, Smith SW, Battista A, Ducharme SA, Carlson JN, Brown CA. Emergency Medicine Postgraduate Year, Laryngoscopic View, and Endotracheal Tube Placement Success. Ann Emerg Med 2024; 84:11-19. [PMID: 38639674 DOI: 10.1016/j.annemergmed.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
STUDY OBJECTIVE Prior work has found first-attempt success improves with emergency medicine (EM) postgraduate year (PGY). However, the association between PGY and laryngoscopic view - a key step in successful intubation - is unknown. We examined the relationship among PGY, laryngoscopic view (ie, Cormack-Lehane view), and first-attempt success. METHODS We performed a retrospective analysis of the National Emergency Airway Registry, including adult intubations by EM PGY 1 to 4 resident physicians. We used inverse probability weighting with propensity scores to balance confounders. We used weighted regression and model comparison to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) between PGY and Cormack-Lehane view, tested the interaction between PGY and Cormack-Lehane view on first-attempt success, and examined the effect modification of Cormack-Lehane view on the association between PGY and first-attempt success. RESULTS After exclusions, we included 15,453 first attempts. Compared to PGY 1, the aORs for a higher Cormack-Lehane grade did not differ from PGY 2 (1.01; 95% CI 0.49 to 2.07), PGY 3 (0.92; 0.31 to 2.73), or PGY 4 (0.80; 0.31 to 2.04) groups. The interaction between PGY and Cormack-Lehane view was significant (P-interaction<0.001). In patients with Cormack-Lehane grade 3 or 4, the aORs for first-attempt success were higher for PGY 2 (1.80; 95% CI 1.17 to 2.77), PGY 3 (2.96; 1.66 to 5.27) and PGY 4 (3.10; 1.60 to 6.00) groups relative to PGY 1. CONCLUSION Compared with PGY 1, PGY 2, 3, and 4 resident physicians obtained similar Cormack-Lehane views but had higher first-attempt success when obtaining a grade 3 or 4 view.
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Affiliation(s)
| | - Joseph Offenbacher
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Michael D April
- 14th Field Hospital, Fort Stewart, GA; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY; Institute for Innovations in Medical Education, New York University Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Anthony Battista
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Scott A Ducharme
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Calvin A Brown
- Department of Emergency Medicine, UMass Chan-Lahey Hospital and Medical Center, Burlington, MA
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Kent ME, Sciavolino BM, Blickley ZJ, Pasichow SH. Video Laryngoscopy versus Direct Laryngoscopy for Orotracheal Intubation in the Out-of-Hospital Environment: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2023; 28:221-230. [PMID: 37256300 DOI: 10.1080/10903127.2023.2219727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the effect of video and direct laryngoscopy on first-pass success rates for out-of-hospital orotracheal intubation. METHODS MEDLINE, Embase, and Cochrane databases were searched from inception to January 2023. Out-of-hospital studies comparing video and direct laryngoscopy on either first-pass or overall intubation success were included. A random effects meta-analysis was performed with a primary outcome of first-pass success stratified by clinician type and laryngoscope blade geometry. The secondary outcomes were overall intubation success stratified by clinician type, and intubation time. All hypotheses and subgroup analyses were determined a priori. RESULTS Twenty-five studies involving 35,489 intubations met inclusion criteria. Substantial heterogeneity (>75%) precluded reporting point estimates for nearly all analyses. For our primary outcome, video laryngoscopy was associated with improved first-pass success in 3/5 physician studies, 4/6 critical care paramedic/registered nurse studies, and 7/10 paramedic studies. Video laryngoscope devices with Macintosh blade geometry were associated with improved first-pass success in 7/10 studies, while devices with hyperangulated geometry were associated with improved first-pass success in 3/7 studies. Overall intubation success was greater with video laryngoscopy in 2/6 studies in the physician subgroup and 9/10 studies in the paramedic subgroup. Video laryngoscopy was not associated with overall intubation success among critical care paramedics/nurses (OR = 1.89, 0.96 to 3.72, I2 = 34%). Lastly, 4/5 studies found video laryngoscopy to be associated with longer intubation times. CONCLUSIONS We found substantial heterogeneity among out-of-hospital studies comparing video laryngoscopy to direct laryngoscopy on first-pass success, overall success, or intubation time. This heterogeneity was not explained with stratification by study design, clinician type, video laryngoscope blade geometry, or leave-one-out meta-analysis. A majority of studies showed that video laryngoscopy was associated with improved first pass success in all subgroups, but only for paramedics and not physicians when looking at overall success. This improvement was more common in studies that used Macintosh blades than those that used hyperangulated blades. Future research should explore the heterogeneity identified in our analysis with an emphasis on differences in training, clinical milieu, and specific video laryngoscope devices.
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Affiliation(s)
- Matthew E Kent
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Scott H Pasichow
- Division of Emergency Medical Services, Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Shappell E, Dutta S, Sakaria S, McEvoy DS, Egan DJ. Variability in Emergency Department Procedure Rates and Distributions in a Regional Health System: A Cross-Sectional Observational Study. Ann Emerg Med 2023; 81:624-629. [PMID: 36775723 DOI: 10.1016/j.annemergmed.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/17/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
STUDY OBJECTIVE Procedural competency is essential to the practice of emergency medicine. However, there are limited data quantifying emergency department procedural volumes to inform the work of educators and credentialing bodies. In this study, we characterize procedural scope and volume in a regional health care system and compare rates between practice settings and over time. METHODS Cross-sectional data were acquired from electronic medical records of a regional health care system from March 2017 through February 2022. Nonspecific entries, esoteric procedures, and nonprocedural clinical skills were excluded. Procedural rates were compared: (1) between academic and community hospitals, (2) across study years, and (3) across seasons. Analyses were repeated for pediatric encounters, and with study year 4 removed to assess the influence of the first year of the coronavirus disease 2019 pandemic on results. RESULTS There were 131,976 instances of 40 qualifying procedures in 1,979,935 unique visits across 9 EDs. Several high-acuity procedures had similar rates in academic and community settings, including cardiac pacing, cricothyrotomy, and lateral canthotomy. Year-over-year procedural rates were stable or increasing for most procedures, with a notable exception of lumbar puncture. Most procedures did not have significant seasonal variation, and most findings were stable when study year 4 was removed from the analysis. CONCLUSION All procedures were performed in all settings and rates of several emergent procedures were similar in both settings, underscoring the importance of broad procedural competence for all emergency physicians. Educators and credentialing organizations can use these data to inform decisions regarding curriculum design and certification requirements.
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Affiliation(s)
- Eric Shappell
- Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
| | - Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA; Mass General Brigham Digital Health, Boston, MA
| | - Sangeeta Sakaria
- Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - Daniel J Egan
- Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
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Gottlieb M, Cooney R, King A, Mannix A, Krzyzaniak S, Jordan J, Shappell E, Fix M. Trends in point-of-care ultrasound use among emergency medicine residency programs over a 10-year period. AEM EDUCATION AND TRAINING 2023; 7:e10853. [PMID: 37008649 PMCID: PMC10061573 DOI: 10.1002/aet2.10853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 06/19/2023]
Abstract
Background Point-of-care ultrasound (POCUS) is increasingly utilized in emergency medicine (EM). While residents are required by the Accreditation Council for General Medical Education to complete a minimum of 150 POCUS examinations before graduation, the distribution of examination types is not well-described. This study sought to assess the number and distribution of POCUS examinations completed during EM residency training and evaluate trends over time. Methods This was a 10-year retrospective review of POCUS examinations across five EM residency programs. The study sites were deliberately selected to represent diversity in program type, program length, and geography. Data from EM residents graduating from 2013 to 2022 were eligible for inclusion. Exclusion criteria were residents in combined training programs, residents who did not complete all training at one institution, and residents who did not have data available. Examination types were identified from the American College of Emergency Physicians guidelines for POCUS. Each site obtained POCUS examination totals for every resident upon graduation. We calculated the mean and 95% confidence interval for each procedure across study years. Results A total of 535 residents were eligible for inclusion, with 524 (97.9%) meeting all inclusion criteria. The mean number of POCUS examinations per resident increased by 46.9% from 277 in 2013 to 407 in 2022. All examination types had stable or increasing frequency. Focused assessment with sonography in trauma (FAST), cardiac, obstetric/gynecologic, and renal/bladder were performed most frequently. Ocular, deep venous thrombosis, musculoskeletal, skin/soft tissue, thoracic, and cardiac examinations had the largest percentage increase in numbers over the 10-year period, while bowel and testicular POCUS remained rare. Conclusions There was an overall increase in the number of POCUS examinations performed by EM residents over the past 10 years, with FAST, cardiac, obstetric/gynecologic, and renal/bladder being the most common examination types. Among less common procedures, increased frequency may be needed to ensure competence and avoid skill decay for those examination types. This information can help inform POCUS training in residency and accreditation requirements.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Robert Cooney
- Department of Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - Andrew King
- Department of Emergency MedicineThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Alexandra Mannix
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Sara Krzyzaniak
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Jaime Jordan
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Eric Shappell
- Department of Emergency MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMassachusettsUSA
| | - Megan Fix
- Department of Emergency MedicineUniversity of Utah HospitalSalt Lake CityUtahUSA
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6
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Gottlieb M, Jordan J, Krzyzaniak S, Mannix A, King A, Cooney R, Fix M, Shappell E. Trends in emergency medicine resident procedural reporting over a 10-year period. AEM EDUCATION AND TRAINING 2023; 7:e10841. [PMID: 36777101 PMCID: PMC9899625 DOI: 10.1002/aet2.10841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 06/18/2023]
Abstract
Background Procedural competency is expected of all emergency medicine (EM) residents upon graduation. The ACGME requires a minimum number of essential procedures to successfully complete training. However, data are limited on the actual number of procedures residents perform and prior studies are limited to single institutions over short time periods. This study sought to assess the number of Key Index Procedures completed during EM residency training and evaluate trends over time. Methods We conducted a retrospective review of graduating EM resident procedure logs across eight ACGME accredited residency programs over the last 10 years (2013-2022). Sites were selected to ensure diversity of program length, program type, and geography. All data from EM residents graduating in 2013-2022 were eligible for inclusion. Data from residents from combined training programs, those who did not complete their full training at that institution (i.e., transferred in/out), or those who did not have data available were excluded. We determined the list of procedures based upon the ACGME Key Index Procedures list. Sites obtained totals for each of the identified procedures for each resident upon graduation. We calculated the mean and 95% CI for each procedure. Results We collected data from a total of 914 residents, with 881 (96.4%) meeting inclusion criteria. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubation. The least frequent procedures included pericardiocentesis, cricothyroidotomy, cardiac pacing, vaginal delivery, and chest tubes. Most procedures were stable over time with the exception of lumbar punctures (decreased) and point-of-care ultrasound (increased). Conclusions In a national sample of EM programs, procedural numbers remained stable except for lumbar puncture and ultrasound. This information can inform residency training curricula and accreditation requirements.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Jaime Jordan
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Sara Krzyzaniak
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Alexandra Mannix
- Department of Emergency MedicineUniversity of Florida College of Medicine – JacksonvilleJacksonvilleFloridaUSA
| | - Andrew King
- Department of Emergency MedicineThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Robert Cooney
- Department of Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - Megan Fix
- Department of Emergency MedicineUniversity of Utah HospitalSalt Lake CityUtahUSA
| | - Eric Shappell
- Department of Emergency MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMassachusettsUSA
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Briggs B, Kalra S, Masneri D, Husain I. Impact of a Focused Online Teaching Module on Airway Intervention: Can an Online Teaching Module Enable Knowledge Acquisition and Increased Confidence in Airway Management? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231192335. [PMID: 37706174 PMCID: PMC10496465 DOI: 10.1177/23821205231192335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/17/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Teaching procedural skills via digital platforms is challenging. There is a paucity of literature on the feasibility of implementing an online asynchronous web-based learning (WBL) module for endotracheal intubation in Emergency Medicine. Learners completed a pre-test questionnaire prior to reviewing the module to assess their current knowledge. After completion of the online module, another assessment on airway management competency was completed. The purpose of our pilot study was to determine the feasibility of implementing an online airway module and investigate knowledge acquisition among learners who completed it. Additionally, we compared the relationship between pre-module confidence and knowledge between various training levels of those who completed the module. METHODS The study was IRB exempt. We conducted a quasi-experimental pre- and post-test study, where learners took a multiple-choice question-based test before watching content module, and after completion of modules, they went on to complete post-test questions. All responses were collected using Google survey and the data were collected over a period of 6 months. We performed descriptive statistics for the pre- and post-module. Frequency distribution was used for data summarization and chi-square test was used to assess the difference between variables. RESULTS We received 366 responses in the pre-test module and 105 in post-test module. Responses were summarized into 5 broad categories which assessed knowledge about airway technique, anatomical landmarks, formulas for selecting blade size, tube size, depth of tube, and case-based scenarios. All questions showed a higher percentage of correct answers in the post-assessment compared to the pre-assessment. CONCLUSION The results demonstrated that this WBL airway module resulted in significant knowledge acquisition, as well as increased confidence when approaching airway management. The study demonstrated that a WBL airway module is a feasible method of asynchronous education for healthcare providers in all levels of training.
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Affiliation(s)
- Blake Briggs
- Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Sarathi Kalra
- Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Masneri
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Iltifat Husain
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Yee J, San Miguel C, Khandelwal S, Way D, Panchal A. Procedural Curriculum to Verify Intern Competence Prior to Patient Care. West J Emerg Med 2023; 24:8-14. [PMID: 36602482 PMCID: PMC9897246 DOI: 10.5811/westjem.2022.11.58057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Emergency medicine (EM) programs train residents to perform clinical procedures with known iatrogenic risks. Currently, there is no established framework for graduating medical students to demonstrate procedural competency prior to matriculating into residency. Mastery-based learning has demonstrated improved patient-safety outcomes. Incorporation of this framework allows learners to demonstrate procedural competency to a predetermined standard in the simulation laboratory prior to performing invasive procedures on patients in the clinical setting. This study describes the creation and implementation of a competency-based procedural curriculum for first-year EM residents using simulation to prepare learners for supervised participation in procedures during patient care. METHODS Checklists were developed internally for five high-risk procedures (central venous line placement, endotracheal intubation, lumbar puncture, paracentesis, chest tube placement). Performance standards were developed using Mastery-Angoff methods. Minimum passing scores were determined for each procedure. Over a two-year period, 38 residents underwent baseline assessment, deliberate practice, and post-testing against the passing standard score to demonstrate procedural competency in the simulation laboratory during intern orientation. RESULTS We found that 37% of residents required more than one attempt to achieve the minimum passing score on some procedures, however, all residents ultimately met the competency standard on all five high-risk procedures in simulation. One critical incident of central venous catheter guideline retention was identified in the simulation laboratory during the second year of implementation. CONCLUSION All incoming first-year EM residents demonstrated procedural competence on five different procedures using a mastery-based educational framework. A competency-based EM curriculum allowed for demonstration of procedural competence prior to resident participation in supervised clinical patient care.
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Affiliation(s)
- Jennifer Yee
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Christopher San Miguel
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Sorabh Khandelwal
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - David Way
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Ashish Panchal
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
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Langsted ST, Lauridsen KG, Weile JB, Skaarup SH, Kirkegaard H, Løfgren B. Lack of Thoracentesis Competencies and Training in Danish Emergency Departments: A Danish Nationwide Study. Open Access Emerg Med 2022; 14:609-614. [PMID: 36411796 PMCID: PMC9675400 DOI: 10.2147/oaem.s384608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/20/2022] [Indexed: 09/08/2024] Open
Abstract
Background Dyspnea caused by pleural effusion is a common reason for admission to the emergency department (ED). In such cases, thoracentesis performed in the ED may allow for swift symptom relief, diagnostics, and early patient discharge. However, the competence level of thoracentesis and training in the ED are currently unclear. This study aimed to describe the current competencies and training in thoracentesis in Danish EDs. Methods We performed a nationwide cross-sectional study in Denmark. A questionnaire was distributed to all EDs in March 2022 including questions on competencies and thoracentesis training methods. Descriptive statistics were used. Results In total, 21 EDs replied (response rate 100%) between March and May 2022. Overall, 50% of consultant and 77% of physicians in emergency medicine specialist training were unable to perform thoracentesis independently. Only 2 of 21 EDs (10%) had a formalized training program. In these 2 EDs, there were no requirements of maintaining these competences. Informal training was reported by 14 out 21 (66%) EDs and consisted of ad-hoc bedside procedural demonstration and/or guidance. Among the 19 EDs without formalized training, 9 (47%) had no intention of establishing a formalized training program. Conclusion We found a major lack of thoracentesis competencies in Danish EDs among both consultant and physicians in emergency medicine specialist training. Moreover, the vast majority of EDs had no formalized thoracentesis training program.
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Affiliation(s)
- Sandra Thun Langsted
- Department of Emergency Medicine, Randers Regional Hospital, Randers, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Jesper Bo Weile
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bo Løfgren
- Department of Emergency Medicine, Randers Regional Hospital, Randers, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
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10
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The Difficult Airway Redefined. Prehosp Disaster Med 2022; 37:723-726. [DOI: 10.1017/s1049023x22001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
There is no all-encompassing or universally accepted definition of the difficult airway, and it has traditionally been approached as a problem chiefly rooted in anesthesiology. However, with airway obstruction reported as the second leading cause of mortality on the battlefield and first-pass success (FPS) rates for out-of-hospital endotracheal intubation (ETI) as low as 46.4%, the need to better understand the difficult airway in the context of the prehospital setting is clear. In this review, we seek to redefine the concept of the “difficult airway” so that future research can target solutions better tailored for prehospital, and more specifically, combat casualty care. Contrasting the most common definitions, which narrow the scope of practice to physicians and a handful of interventions, we propose that the difficult airway is simply one that cannot be quickly obtained. This implies that it is a situation arrived at through a multitude of factors, namely the Patient, Operator, Setting, and Technology (POST), but also more importantly, the interplay between these elements. Using this amended definition and approach to the difficult to manage airway, we outline a target-specific approach to new research questions rooted in this system-based approach to better address the difficult airway in the prehospital and combat casualty care settings.
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Lavoie ME, Tay KY, Nadel F. Who Trains the Trainers?: Development of a Faculty Bootcamp for Pediatric Emergency Medicine Resuscitation Procedures. Pediatr Emerg Care 2022; 38:353-357. [PMID: 35787583 DOI: 10.1097/pec.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Attending physicians in pediatric emergency medicine (PEM) must be able to perform lifesaving procedures, yet guidelines for maintaining procedural competency do not exist. We implemented a biannual 2-hour "bootcamp" designed to help PEM faculty maintain procedural competency. METHODS A survey-based needs assessment was used to create a set of goals and objectives for the session and determine which procedural skills to include. Sessions of 4 simulated skills were held twice a year and limited to 12 faculty. Post-bootcamp evaluations were administered at the 1-year and 6-year marks to evaluate the usefulness of the training. RESULTS Twenty-eight of our 55 current faculty members (50%) responded to the 6-year follow-up evaluation. Overall, the bootcamp was felt to be beneficial, with 64% of faculty rating it "great" (5) or "highly useful" (6) on a 6-point Likert scale. The majority of participants also rated the airway, vascular access, and cardiopulmonary resuscitation/defibrillator training favorably. Faculty who later had the opportunity to perform specific resuscitation procedures clinically felt that the circulation (cardiopulmonary resuscitation/defibrillator) and airway stations contributed to the success of their procedure performance. CONCLUSIONS The clinical setting alone may be insufficient in maintaining procedural competency in lifesaving skills in PEM. Giving faculty the opportunity to practice these skills is feasible and can be effective in increasing confidence. Future training sessions should aim toward practicing to a defined mastery level.
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Affiliation(s)
- Megan E Lavoie
- From the Perelman School of Medicine at the University of Pennsylvania; and Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Emergency medicine (EM) can safely manage geriatric trauma patients sustaining ground level falls: Fostering EM autonomy while safely offloading a busy trauma service. Am J Surg 2022; 224:1314-1318. [DOI: 10.1016/j.amjsurg.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
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Haidar DA, Kessler R, Khanna NK, Cover MT, Burkhardt JC, Theyyunni N, Tucker RV, Huang RD, Holman E, Bridge PD, Klein KA, Fung CM. Association of a longitudinal, preclinical ultrasound curriculum with medical student performance. BMC MEDICAL EDUCATION 2022; 22:50. [PMID: 35062942 PMCID: PMC8780388 DOI: 10.1186/s12909-022-03108-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Point-of-care ultrasound (US) is used in clinical practice across many specialties. Ultrasound (US) curricula for medical students are increasingly common. Optimal timing, structure, and effect of ultrasound education during medical school remains poorly understood. This study aims to retrospectively determine the association between participation in a preclinical, longitudinal US curriculum and medical student academic performance. METHODS All first-year medical students at a medical school in the Midwest region of the United States were offered a voluntary longitudinal US curriculum. Participants were selected by random lottery. The curriculum consisted of five three-hour hands on-sessions with matching asynchronous content covering anatomy and pathologic findings. Content was paired with organ system blocks in the standard first year curriculum at our medical school. Exam scores between the participating and non-participating students were compared to evaluate the objective impact of US education on performance in an existing curriculum. We hypothesized that there would be an association between participation in the curriculum and improved medical student performance. Secondary outcomes included shelf exam scores for the surgery, internal medicine, neurology clerkships and USMLE Step 1. A multivariable linear regression model was used to evaluate the association of US curriculum participation with student performance. Scores were adjusted for age, gender, MCAT percentile, and science or engineering degree. RESULTS 76 of 178 students applied to participate in the curriculum, of which 51 were accepted. US curriculum students were compared to non-participating students (n = 127) from the same class. The US curriculum students performed better in cardiovascular anatomy (mean score 92.1 vs. 88.7, p = 0.048 after adjustment for multiple comparisons). There were no significant differences in cumulative cardiovascular exam scores, or in anatomy and cumulative exam scores for the gastroenterology and neurology blocks. The effect of US curriculum participation on cardiovascular anatomy scores was estimated to be an improvement of 3.48 points (95% CI 0.78-6.18). No significant differences were observed for USMLE Step 1 or clerkship shelf exams. There were no significant differences in either preclinical, clerkship or Step 1 score for the 25 students who applied and were not accepted and the 102 who did not apply. CONCLUSIONS Participation in a preclinical longitudinal US curriculum was associated with improved exam performance in cardiovascular anatomy but not examination of other cardiovascular system concepts. Neither anatomy or comprehensive exam scores for neurology and gastrointestinal organ system blocks were improved.
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Affiliation(s)
- David A Haidar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ross Kessler
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Neil K Khanna
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael T Cover
- Department of Emergency Medicine, University Hospitals, Cleveland, Ohio, USA
| | - John C Burkhardt
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Nik Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan V Tucker
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rob D Huang
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Holman
- Office of Evaluation and Assessment, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Patrick D Bridge
- Office of Evaluation and Assessment, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Katherine A Klein
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.
- Taubman Center, B1-380A 1500 E. Medical Center Dr., SPC 5305, 48109, Ann Arbor, USA, MI.
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Grissom TE, Samet RE. The Anesthesiologist's Role in Teaching Airway Management to Nonanesthesiologists: Who, Where, and How. Adv Anesth 2021; 38:131-156. [PMID: 34106831 PMCID: PMC7534755 DOI: 10.1016/j.aan.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Thomas E Grissom
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, T1R77, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Ron E Samet
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, T1R77, 22 South Greene Street, Baltimore, MD 21201, USA
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Declines in the Number of Lumbar Punctures Performed at United States Children's Hospitals, 2009-2019. J Pediatr 2021; 231:87-93.e1. [PMID: 33080276 DOI: 10.1016/j.jpeds.2020.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate trends in lumbar puncture (LP) performance among US children's hospitals to assess how these trends may impact pediatric resident trainee exposure to LP. STUDY DESIGN We quantified LPs for emergency department (ED) and inpatient encounters at 29 US children's hospitals from 2009 to 2019. LP was defined by either a LP procedure code or cerebrospinal fluid culture billing code. Temporal trends and hospital variation in LP were assessed using logistic regression analysis. RESULTS A total of 215 030 LPs were performed during the study period (0.8% of all encounters). Twenty six thousand and five hundred twenty three and 16 696 LPs were performed in the 2009 and 2018 academic years, respectively (overall 37.1% reduction, per-year OR, 0.935; 95% CI, 0.922-0.948; P < .001), and the rate of LP decreased from 10.9 per 1000 hospital encounters to 6.0 per 1000 hospital encounters over the same period. CONCLUSIONS LP rates have declined across US children's hospitals over the past decade, potentially resulting in reduced clinical exposure for pediatric resident trainees. Improved procedural simulation during residency may augment the clinical experience.
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Abdu B, Akolkar S, Picking C, Boura J, Piper M. Factors Associated with Delayed Paracentesis in Patients with Spontaneous Bacterial Peritonitis. Dig Dis Sci 2021; 66:4035-4045. [PMID: 33274417 PMCID: PMC8510927 DOI: 10.1007/s10620-020-06750-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM In patients with spontaneous bacterial peritonitis (SBP), studies show that delayed paracentesis (DP) is associated with worse outcomes and mortality. We aimed to assess the rate of DP in the community setting and associated factors with early versus delayed paracentesis. METHODS Patients hospitalized with SBP were retrospectively studied between 12/2013 and 12/2018. DP was defined as paracentesis performed > 12 h from initial encounter. Data collected included: patient factors (i.e., age, race, symptoms, history of SBP, MELD) and physician factors (i.e., admission service, shift times, providers ordering and performing paracentesis). Logistic regression analysis was performed to assess for factors associated with DP. RESULTS DP occurred 82% of the time (n = 97). The most significant factors in predicting timing of paracentesis were ordering physician [emergency department (ED) physician was associated with early paracentesis (57% vs 8%, p < 0.001) and specialty of physician performing paracentesis (interventional radiology was associated with DP (88% vs 48%, p < 0.001)]. Younger patients were more likely to receive early paracentesis. In regression analysis, the factor most associated with early paracentesis was when the order was made by the ED provider (OR 0.07, 95% CI 0.02-0.22). No differences were observed in patients with prior history of SBP, abdominal pain, encephalopathy, or creatinine level. CONCLUSIONS Studies have suggested that DP is associated with increased mortality in patients with SBP. Despite this, DP is common in the community setting and is influenced by ordering physician and specialty of physician performing paracentesis. Future efforts should assess interventions to improve this important quality indicator.
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Affiliation(s)
- Backer Abdu
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Shalaka Akolkar
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Christopher Picking
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Judith Boura
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Marc Piper
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
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Berard D, Navarro JD, Bascos G, Harb A, Feng Y, De Lorenzo R, Hood RL, Restrepo D. Novel expandable architected breathing tube for improving airway securement in emergency care. J Mech Behav Biomed Mater 2020; 114:104211. [PMID: 33285451 DOI: 10.1016/j.jmbbm.2020.104211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.
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Affiliation(s)
- David Berard
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Juan David Navarro
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Gregg Bascos
- University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA
| | - Angel Harb
- University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA
| | - Yusheng Feng
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Robert De Lorenzo
- University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, TX, USA
| | - R Lyle Hood
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA; University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA; University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, TX, USA
| | - David Restrepo
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA.
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Mosier JM, Sakles JC, Law JA, Brown CA, Brindley PG. Tracheal Intubation in the Critically Ill. Where We Came from and Where We Should Go. Am J Respir Crit Care Med 2020; 201:775-788. [DOI: 10.1164/rccm.201908-1636ci] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jarrod M. Mosier
- Department of Emergency Medicine and
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, Tucson, Arizona
| | | | - J. Adam Law
- Department of Anesthesiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Calvin A. Brown
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Peter G. Brindley
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
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Videolaryngoscopy and Direct Laryngoscopy Equal for Air Medical Intubation? The Operator Matters. Crit Care Med 2020; 48:e254-e255. [DOI: 10.1097/ccm.0000000000004118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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