- Email: [email protected]
38 System-Based Practice and Cost Awareness: Can Emergency Medicine Residents Accurately Predict the Cost-Common Emergency Department Laboratory Tests?
CORD Abstracts into the residency curriculum as means to transmit high-quality knowledge and introduce a new mechanism for lifelong learning. Study Objectives: This study aims to assess resident satisfaction and compliance with educational requirements of our new blog-format Web site (www.media.sinaiem.org) for implementation of asynchronous learning goals. Methods: This is a prospective observational cohort study evaluating residents at an urban academic teaching institution between November 2011 and April 2012. All residents in the program will be included and observed as they participate in the asynchronous curriculum, and blinded to the study goals. Residents will be allocated educational credits based on consumption and creation of media and are expected to accrue 10 credits per month. Site users will be quantified by PGY level, individual usage, timing of usage, and types of resources consumed and created. Satisfaction with the media selections will also be assessed. Resident compliance will be gauged by reviewing the number of credits accrued in the allotted time period. Anonymous surveys will be administered pre- and postintervention to assess online resource knowledge. Results: Fifty-eight residents from PGY 1 to 4 are currently enrolled in this study, 34 men and 24 women aged 27 to 35 years. Preliminary results have shown there is a subset of early adopters of the online learning method among newer residents. Overall site usage shows 60% of users are PGY 1 and 2; 40%, PGY 3 and 4. Conclusions: Learning styles are evolving, with younger generations being more comfortable using online education modalities. Further results may show what factors are important in developing new styles and individualizing learning needs.
38
System-Based Practice and Cost Awareness: Can Emergency Medicine Residents Accurately Predict the Cost-Common Emergency Department Laboratory Tests?
Burns B, Tainter C, Gentges J, Swope M, Arthur A/University of Oklahoma College of Medicine, Tulsa, OK
36
Does Placing Senior Residents in a Supervisory Role Increase Number of Patient Encounters?
Hartman ND, Gisondi M, Collings J/McGaw Medical Center of Northwestern University, Chicago, IL
Background: Adequate case experience forms the foundation of graduate medical education. As duty-hour regulations constrain residency programs in allowing residents to see a sufficient number of patients, new strategies are needed to ensure that residents accumulate quality patient encounters. Studies have suggested that emergency medicine residents, working on their own under the supervision of an attending physician, plateau in the number of patients seen per hour between the second and third year of residency. Placing senior residents in supervisory roles may allow them to see more patients in the course of limited clinical time. Study Objectives: We sought to determine if a system in which third- and fourthyear residents spend much of their time acting in a supervisory role in the ED would appreciably increase case exposure during those residency years. Methods: Our residency program in an urban emergency department allows third- and fourth-year residents to supervise cases with more junior EM residents, rotating interns, and medical students. We compared patients seen per hour among second-year residents with that of third-year residents over the same randomly chosen 2-month period and then compared that difference with what has previously been reported in the literature. Results: The 4 previous studies that were identified showed a mean absolute increase of 0.04 patients seen per hour between EM-2 and EM-3 in emergency medicine programs. The mean percentage change between those years in those studies was 3.2%. EM-3s in our sample saw 2.04 patients per hour, and EM-2s saw 1.55, for an absolute increase of 0.49 patients per hour between those 2 years of residency. The percentage change was 31.6% in our sample. Conclusions: Residents transitioning into their third year of residency saw an appreciably larger increase in their patient exposure in a system that emphasizes supervision by senior residents than what has been seen in previous studies.
37
Background: During postgraduate training, EM residents learn what tests to order based on current scientific evidence, knowledge of disease processes, and direct feedback from their faculty. Typical training curriculum, however, does not include instruction in the actual costs of these tests or their financial burden. Needless and excessive spending may occur without an appropriate understanding of the impact on the larger health care system. Knowledge of the actual costs among EM residents has not been studied, and the actual educational needs in this area are not known. Study Objective: To measure and compare the ability of classes of EM residents to accurately predict the cost to the patient of commonly ordered laboratory tests in the emergency department. Methods: All protocols were reviewed and approved by the IRB. A questionnaire was administered to 20 residents from a single ACGME-accredited 3-year EM residency. Residents provided their best estimation of the cost of each test. The responses were then recorded and trends were calculated and reported. Results: Completion rate was 100%. Significant discrepancies were noted between the median resident EM class estimates and actual laboratory test cost to patient (Table 1). Only 1 test (type and screen) elicited an overall estimate above the actual laboratory cost. The group median underestimation for each remaining test was $114 below the actual cost. There was statistically significant improvement in accuracy between the intern and second year, but improvement between the second and third year was not significant (Figure 1).
A Blog-Format Asynchronous Learning Experience
Lakoff DJ, Strayer RJ, Bentley S, Shah K/Mount Sinai School of Medicine, New York, NY
Background: The recent explosion of online emergency medicine (EM) educational material has drawn the attention of the EM academic community. National EM groups and programs are seeking ways to incorporate new modalities
Volume , . : November
Annals of Emergency Medicine S175
CORD Abstracts (1), and registered nurse (1). The average usefulness of the podcast, the depth of the material, the appropriateness of the topics, and the length of the podcast were 8.6, 9.2, 8.9, and 8.8, respectively. When asked how frequently participants applied knowledge gained from EM Basic to their clinical practice, the average was 5.7. When asked how many times participants applied information from the podcast to their clinical practice, the average was 2.3. Among MS-3 participants (n⫽3), the average was 5.3. Conclusion: A podcast created by an EM resident can have a positive educational impact and be well received. Listeners can identify specific instances where EM Basic assisted them during clinical practice. While limited by sample size, EM education podcasts may have a larger impact on third-year medical students, given the increased frequency at which they apply what they learn on the podcast. The full results of this survey will further examine this association.
41
Innovating Patient Follow-up Logs: An Evaluation of the Initial Learner-Generated Content
Marinelli M, Patton M, Salzman DH/McGaw Medical Center of Northwestern University, Chicago, IL
Conclusions: Although there was improvement after the EM-1 year, each group performed poorly. This suggests major knowledge deficiencies in this area, which may be significant barriers to cost-effective emergency care. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula and warrants further identification and study.
39
A Novel Web-Based ECG Curriculum Compared to Traditional Lecture-Based Method at an Emergency Medicine Residency
Johnson R/Vidant Medical Center/East Carolina University, Greenville, NC
Background: Web-based and computer-aided technology has become of increased interest in graduate medical education. Interestingly, scholarly work has shown no difference in effectiveness between these and traditional methods. Currently, there are limited numbers of articles describing and evaluating these advances, especially in the field of emergency medicine. Study Objective: Evaluate the effectiveness of a Web-based ECG curriculum as compared to a traditional lecture-based curriculum at an emergency medicine residency. Methods: Emergency medicine residents completed a 2-month ECG curriculum via a traditional lecture-based format and then evaluated using a diagnostic examination. They were also asked their opinions on ECG interpretation. Three years later, a different cohort of residents underwent a similar Web-based curriculum and was given the same examination and survey. Results: Forty-six residents (24 in 2008, 21 in 2011) completed the survey and examination. There was no difference in examination score (P⫽.13) or comfort level interpreting EKGs (P⫽.13). Conclusions: Our findings are consistent with current literature comparing Webbased and traditional methods. Results are limited due to sample size, as well as adherence to ECG curriculum. More research into improving application of technology may improve outcomes
40
A Survey on the Educational Impact of a ResidentProduced Emergency Medicine Education Podcast
Carroll SM, Thaxton RE/San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
Background: Podcasts are a popular method of asynchronous learning among emergency medicine (EM) residents. EM Basic is a free audio podcast created and produced by an EM senior resident. Each episode discusses a common EM chief complaint at the level of a medical student or intern. EM Basic has 10 episodes to date, with over 10,000 global downloads. Study Objective: Quantify the educational impact of EM Basic. We report an interim analysis of an ongoing survey. Methods: Listeners of EM Basic were asked to complete an anonymous 10question survey. The survey asked for the listeners’ level of training, how useful they found the podcast, and how many times the podcast assisted them during a clinical shift. Each subjective question was scored on a 1 to 10 scale. Results: Twenty-four surveys were completed. Participants reported listening to an average of 3.3 episodes. Participants identified themselves as MS-1 (n⫽1), MS-3 (3), MS-4 (1), EM-1 (3), EM-2 (6), EM-3 (6), EM physician assistant (2), attending
S176 Annals of Emergency Medicine
Background: The RRC for emergency medicine requires that programs ensure that residents follow up on a representative sample of patients. Residency programs have flexibility in accomplishing this goal and developed an innovative blog for patient follow-up logs. Hypothesis: We hypothesized that this platform would allow residents to meet patient follow-up requirements, provide an opportunity for self-directed learning, and generate content covering the entire spectrum of emergency medicine. Methods: In this IRB-approved study, 2 authors independently coded the main content of all posts in the patient follow-up blog according to the categories of the 2009 Model of the Clinical Practice of Emergency Medicine (2009 MEM). The number of learning topics generated, references cited, and number and type of images included in the posts were also recorded. After independent coding, all authors met to reach consensus. Results: During the first 4 blocks of implementation, 45 residents generated 283 independent posts. Content was lost from 23 posts (7%). The remaining 260 posts were analyzed and covered every main category of the 2009 MEM. Posts predominantly related to trauma (19.6%), drugs and chemical classes (6.2%), stroke (4.2%), and disturbances of cardiac rhythm (4.2%). Each post contained an average of 1.04 learning points, 1.22 images or attachments, and 1.38 references. Longitudinal follow-up of patient clinical course was included in 138 posts (53%). Conclusion: Despite the apparently only moderate success in meeting the RRC follow-up requirements, this blog is potentially more effective than prior methods as previously patient follow-up logs were tallied for completion, not content. Without specific instruction, one EM residency program covered all main topics and almost half of all subcategories in the 2009 MEM in only 4 months. Reference and image utilization indicates the blog created an effective scaffold to encourage self-directed learning.
42
Acute Care and Injury Prevention Longitudinal Ambulatory Care Experience: A Curricular Innovation
Bezek S, Hoxhaj S, Kapur B, Cao D, Finn R/Baylor College of Medicine, Houston, TX; Carolinas Medical Center, Charlotte, NC
Background: The Longitudinal Ambulatory Care Experience (LACE) is a yearlong course for third-year medical students at Baylor College of Medicine, designed to increase their knowledge of common conditions affecting ambulatory patients. The Acute Care and Injury Prevention (ACIP) LACE is a new, alternative pathway for select students based in the Emergency Center (EC) that focuses on integrating outof-hospital systems, acute ambulatory patient care, injury prevention, and appropriate support service utilization. Study Objective: That students in the ACIP LACE pathway develop a comprehensive understanding of EC patient management and the role of multidisciplinary support services. Methods: The ACIP LACE course occurs weekly, and students rotate through an EC preceptor and community experience. During the preceptor experience, students focus on patients with acute exacerbations of chronic problems or those who may benefit from injury prevention education. Students follow up with 1 patient weekly to elicit how the patient has progressed. During the community experience, students rotate through a myriad of sites designed to demonstrate the important and varied roles support services play in ensuring proper patient care. Students reflect on these
Volume , . : November
38
System-Based Practice and Cost Awareness: Can Emergency Medicine Residents Accurately Predict the Cost-Common Emergency Department Laboratory Tests?
Burns B, Tainter C, Gentges J, Swope M, Arthur A/University of Oklahoma College of Medicine, Tulsa, OK
36
Does Placing Senior Residents in a Supervisory Role Increase Number of Patient Encounters?
Hartman ND, Gisondi M, Collings J/McGaw Medical Center of Northwestern University, Chicago, IL
Background: Adequate case experience forms the foundation of graduate medical education. As duty-hour regulations constrain residency programs in allowing residents to see a sufficient number of patients, new strategies are needed to ensure that residents accumulate quality patient encounters. Studies have suggested that emergency medicine residents, working on their own under the supervision of an attending physician, plateau in the number of patients seen per hour between the second and third year of residency. Placing senior residents in supervisory roles may allow them to see more patients in the course of limited clinical time. Study Objectives: We sought to determine if a system in which third- and fourthyear residents spend much of their time acting in a supervisory role in the ED would appreciably increase case exposure during those residency years. Methods: Our residency program in an urban emergency department allows third- and fourth-year residents to supervise cases with more junior EM residents, rotating interns, and medical students. We compared patients seen per hour among second-year residents with that of third-year residents over the same randomly chosen 2-month period and then compared that difference with what has previously been reported in the literature. Results: The 4 previous studies that were identified showed a mean absolute increase of 0.04 patients seen per hour between EM-2 and EM-3 in emergency medicine programs. The mean percentage change between those years in those studies was 3.2%. EM-3s in our sample saw 2.04 patients per hour, and EM-2s saw 1.55, for an absolute increase of 0.49 patients per hour between those 2 years of residency. The percentage change was 31.6% in our sample. Conclusions: Residents transitioning into their third year of residency saw an appreciably larger increase in their patient exposure in a system that emphasizes supervision by senior residents than what has been seen in previous studies.
37
Background: During postgraduate training, EM residents learn what tests to order based on current scientific evidence, knowledge of disease processes, and direct feedback from their faculty. Typical training curriculum, however, does not include instruction in the actual costs of these tests or their financial burden. Needless and excessive spending may occur without an appropriate understanding of the impact on the larger health care system. Knowledge of the actual costs among EM residents has not been studied, and the actual educational needs in this area are not known. Study Objective: To measure and compare the ability of classes of EM residents to accurately predict the cost to the patient of commonly ordered laboratory tests in the emergency department. Methods: All protocols were reviewed and approved by the IRB. A questionnaire was administered to 20 residents from a single ACGME-accredited 3-year EM residency. Residents provided their best estimation of the cost of each test. The responses were then recorded and trends were calculated and reported. Results: Completion rate was 100%. Significant discrepancies were noted between the median resident EM class estimates and actual laboratory test cost to patient (Table 1). Only 1 test (type and screen) elicited an overall estimate above the actual laboratory cost. The group median underestimation for each remaining test was $114 below the actual cost. There was statistically significant improvement in accuracy between the intern and second year, but improvement between the second and third year was not significant (Figure 1).
A Blog-Format Asynchronous Learning Experience
Lakoff DJ, Strayer RJ, Bentley S, Shah K/Mount Sinai School of Medicine, New York, NY
Background: The recent explosion of online emergency medicine (EM) educational material has drawn the attention of the EM academic community. National EM groups and programs are seeking ways to incorporate new modalities
Volume , . : November
Annals of Emergency Medicine S175
CORD Abstracts (1), and registered nurse (1). The average usefulness of the podcast, the depth of the material, the appropriateness of the topics, and the length of the podcast were 8.6, 9.2, 8.9, and 8.8, respectively. When asked how frequently participants applied knowledge gained from EM Basic to their clinical practice, the average was 5.7. When asked how many times participants applied information from the podcast to their clinical practice, the average was 2.3. Among MS-3 participants (n⫽3), the average was 5.3. Conclusion: A podcast created by an EM resident can have a positive educational impact and be well received. Listeners can identify specific instances where EM Basic assisted them during clinical practice. While limited by sample size, EM education podcasts may have a larger impact on third-year medical students, given the increased frequency at which they apply what they learn on the podcast. The full results of this survey will further examine this association.
41
Innovating Patient Follow-up Logs: An Evaluation of the Initial Learner-Generated Content
Marinelli M, Patton M, Salzman DH/McGaw Medical Center of Northwestern University, Chicago, IL
Conclusions: Although there was improvement after the EM-1 year, each group performed poorly. This suggests major knowledge deficiencies in this area, which may be significant barriers to cost-effective emergency care. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula and warrants further identification and study.
39
A Novel Web-Based ECG Curriculum Compared to Traditional Lecture-Based Method at an Emergency Medicine Residency
Johnson R/Vidant Medical Center/East Carolina University, Greenville, NC
Background: Web-based and computer-aided technology has become of increased interest in graduate medical education. Interestingly, scholarly work has shown no difference in effectiveness between these and traditional methods. Currently, there are limited numbers of articles describing and evaluating these advances, especially in the field of emergency medicine. Study Objective: Evaluate the effectiveness of a Web-based ECG curriculum as compared to a traditional lecture-based curriculum at an emergency medicine residency. Methods: Emergency medicine residents completed a 2-month ECG curriculum via a traditional lecture-based format and then evaluated using a diagnostic examination. They were also asked their opinions on ECG interpretation. Three years later, a different cohort of residents underwent a similar Web-based curriculum and was given the same examination and survey. Results: Forty-six residents (24 in 2008, 21 in 2011) completed the survey and examination. There was no difference in examination score (P⫽.13) or comfort level interpreting EKGs (P⫽.13). Conclusions: Our findings are consistent with current literature comparing Webbased and traditional methods. Results are limited due to sample size, as well as adherence to ECG curriculum. More research into improving application of technology may improve outcomes
40
A Survey on the Educational Impact of a ResidentProduced Emergency Medicine Education Podcast
Carroll SM, Thaxton RE/San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
Background: Podcasts are a popular method of asynchronous learning among emergency medicine (EM) residents. EM Basic is a free audio podcast created and produced by an EM senior resident. Each episode discusses a common EM chief complaint at the level of a medical student or intern. EM Basic has 10 episodes to date, with over 10,000 global downloads. Study Objective: Quantify the educational impact of EM Basic. We report an interim analysis of an ongoing survey. Methods: Listeners of EM Basic were asked to complete an anonymous 10question survey. The survey asked for the listeners’ level of training, how useful they found the podcast, and how many times the podcast assisted them during a clinical shift. Each subjective question was scored on a 1 to 10 scale. Results: Twenty-four surveys were completed. Participants reported listening to an average of 3.3 episodes. Participants identified themselves as MS-1 (n⫽1), MS-3 (3), MS-4 (1), EM-1 (3), EM-2 (6), EM-3 (6), EM physician assistant (2), attending
S176 Annals of Emergency Medicine
Background: The RRC for emergency medicine requires that programs ensure that residents follow up on a representative sample of patients. Residency programs have flexibility in accomplishing this goal and developed an innovative blog for patient follow-up logs. Hypothesis: We hypothesized that this platform would allow residents to meet patient follow-up requirements, provide an opportunity for self-directed learning, and generate content covering the entire spectrum of emergency medicine. Methods: In this IRB-approved study, 2 authors independently coded the main content of all posts in the patient follow-up blog according to the categories of the 2009 Model of the Clinical Practice of Emergency Medicine (2009 MEM). The number of learning topics generated, references cited, and number and type of images included in the posts were also recorded. After independent coding, all authors met to reach consensus. Results: During the first 4 blocks of implementation, 45 residents generated 283 independent posts. Content was lost from 23 posts (7%). The remaining 260 posts were analyzed and covered every main category of the 2009 MEM. Posts predominantly related to trauma (19.6%), drugs and chemical classes (6.2%), stroke (4.2%), and disturbances of cardiac rhythm (4.2%). Each post contained an average of 1.04 learning points, 1.22 images or attachments, and 1.38 references. Longitudinal follow-up of patient clinical course was included in 138 posts (53%). Conclusion: Despite the apparently only moderate success in meeting the RRC follow-up requirements, this blog is potentially more effective than prior methods as previously patient follow-up logs were tallied for completion, not content. Without specific instruction, one EM residency program covered all main topics and almost half of all subcategories in the 2009 MEM in only 4 months. Reference and image utilization indicates the blog created an effective scaffold to encourage self-directed learning.
42
Acute Care and Injury Prevention Longitudinal Ambulatory Care Experience: A Curricular Innovation
Bezek S, Hoxhaj S, Kapur B, Cao D, Finn R/Baylor College of Medicine, Houston, TX; Carolinas Medical Center, Charlotte, NC
Background: The Longitudinal Ambulatory Care Experience (LACE) is a yearlong course for third-year medical students at Baylor College of Medicine, designed to increase their knowledge of common conditions affecting ambulatory patients. The Acute Care and Injury Prevention (ACIP) LACE is a new, alternative pathway for select students based in the Emergency Center (EC) that focuses on integrating outof-hospital systems, acute ambulatory patient care, injury prevention, and appropriate support service utilization. Study Objective: That students in the ACIP LACE pathway develop a comprehensive understanding of EC patient management and the role of multidisciplinary support services. Methods: The ACIP LACE course occurs weekly, and students rotate through an EC preceptor and community experience. During the preceptor experience, students focus on patients with acute exacerbations of chronic problems or those who may benefit from injury prevention education. Students follow up with 1 patient weekly to elicit how the patient has progressed. During the community experience, students rotate through a myriad of sites designed to demonstrate the important and varied roles support services play in ensuring proper patient care. Students reflect on these
Volume , . : November