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How Often Do Senior Medical Students Receive Formative Feedback During an Emergency Medicine Clerkship
Research Forum Abstracts were able to interpret the EKG’s with similar competency against the attending physicians interpretations. Results: PGY-3 Emergency Medicine residents correctly interpreted the highest number of EKG’s (69%). No significant difference existed between the attending physicians and the PGY-3 or PGY-2 residents (p=1.00, CI=0.191 - 0.163; p=0.281, CI=-0.030 - 0.232). Significant differences occurred between the PGY-3 versus PGY-1 residents (p=0.035, CI=0.008 - 0.370). No significant difference occurred between the PGY-3 and PGY-2 residents (p=0.673, CI=0.066 - 0.296) or PGY-2 and PGY-1 residents (p=1.00, CI=0.062-0.211). Conclusion: Competency in EKG interpretation occurs during the second year of residency training.
312
Emergency Physicians and the Neurologic Examination
Nagurney JT, Resnick JB, Gatha N, Binder W, Filbin M, Borczuk P, Brown DF, Swap C, Parry B, Chang Y, Massachusetts General Hospital, Boston, MA; Harvard Affiliated Emergency Medicine Residency, Boston, MA; Albany Medical College, Albany, NY; University of California at San Francisco School of Medicine, San Francisco, CA
Study Objectives: Because the neurologic examination (Neurexam) contributes to EP ordering of neuroimaging, we measured its test characteristics as performed by ED faculty and non-neurology residents on ED patients. Methods: We conducted a prospective observational study in the ED of a 76,000-visit university hospital. Care is provided by PGY 1-4 residents in EM, IM and surgery supervised by board-certified or eligible faculty EPs with 1-25 years of experience. Neuromedical and neurosurgical consults are performed by PGY 2 neuroresidents. Providers of adults who received CT or MRI of the brain and a neuromedical consult were studied. Enrollment occurred during all weekdays from July-Oct 2004. The Neurexam of ED providers was abstracted from medical records and coded as normal or focally or globally abnormal. Test characteristics were determined for this Neurexam using the neurologist’s Neurexam as the criterion standard. Results: 113 patients were enrolled with a median age of 57 years; 53% were male. The presenting complaints were a focal neurological deficit (37%), headache (12%) and trauma (12%). Overall, 43% of patients had a prior neurologic history and 50% of neuroimages were acutely abnormal. ED attendings (23) documented Neurexams for 101 patients, and 36 residents for 91. For attendings, the sens of the exam was 79% (95% CI: 68-88%) and the spec was 83% (95% CI: 63-95%). For residents, these figures were 82% (95% CI: 70-90%) and 69% (95% CI: 48-86%) respectively. Among the 61 Neurexams found abnormal by the neurologists, the resident and attending agreed on 58 (95%), but agreed on only 65% of the 20 Neurexams found normal. by the neurologist. Conclusion: The clinical Neurexam as performed on ED patients by faculty EPs and residents has reasonable sens and spec when compared to that of a Neurexam performed by a neurologist. Further analysis of false positive and false negative Neurexams may contribute to medical education and to cost-effectiveness.
313
New Education Delivery System Plays Vital Role in Getting Patients to Emergency Department Within ‘Golden Hour’
Crews MG, Holbrook SE, DeKalb Fire and Rescue Services, Decatur, GA; DeKalb Medical Center, Decatur, GA
Study Objectives: In 2004, a web-based learning system was implemented. This study is designed to determine the effect of web-based learning systems on delivery time to Emergency Departments of patients in an urban setting that meet the Anatomic and Physiologic Criteria components of Trauma Triage Criteria. Methods: This retrospective study was conducted in conjunction with an audit of the eCampus learning system to determine the effectiveness of the system after the first 6 months of operation. A ‘Trauma Triage Criteria’ module consisting of one contact hour was developed and delivered to employees of DeKalb Fire and Rescue Services. The course described the trauma system in great detail, the trauma triage criteria, and it emphasizes the importance of the ‘golden hour’ as well as early communication with hospitals receiving patients meeting these criteria. Pre-hospital patient contact time (time from dispatch to hospital delivery) was measured. Results: In the months preceding the delivery of the Trauma Triage Criteria in-service, the Department saw an average Patient Contact Time of 47.38 minutes.
S88 Annals of Emergency Medicine
The months following the Trauma Triage in-service showed an average Patient Contact Time of 41.39 minutes. This downward trend continues into 2005. Conclusion: The delivery of this web-based training coupled with highly effective system guidelines and managerial practices has led to a system of greater accountability and has resulted in an immediate and sustained drop in Pre-hospital patient contact times for those patients meeting Trauma Triage Criteria. This allows delivery of patients to Emergency Departments with more time left in their ‘‘Golden Hour’’, and therefore they have a better chance to survive their injuries. This low cost and effective learning system can easily be adapted for use in busy, urban Fire/Rescue systems.
314
How Often Do Senior Medical Students Receive Formative Feedback During an Emergency Medicine Clerkship
Wald DA, Barrett J, Temple University School of Medicine, Philadelphia, PA
Study Objectives: Formative feedback (FB) is an essential part of the medical education process. In the setting of clinical medical education, FB refers to information describing a students’ performance in a given activity that is intended to guide their future performance in that same or related activity. However, no data is available on how often senior medical students (MS) receive FB and suggestions for improving clinical performance (SFICP) during an emergency medicine (EM) clerkship. This study sought to determine how often senior MS receive FB and SFICP during an EM clerkship and whether there are any differences in the frequency of FB received by senior MS as compared to that provided by supervising physicians. Methods: From July - December 2004, all 53 students rotating through a busy urban emergency department were surveyed at the completion of their EM clerkship about receiving FB and SFICP from supervising physicians. In the fall of 2004, all 25 EM faculty (FAC) and 8 senior EM residents (SR) were also surveyed about providing FB and SFICP to senior MS. Results: 51 of 53 senior MS (96.2%) completed the survey. All FAC and SR completed the survey. 5.9% of senior MS reported receiving FB during or at the conclusion of every clinical shift, 31.4% - most clinical shifts, 35.3% - some clinical shifts, 23.5% - few clinical shifts, and 3.9% of senior MS reported that they did not receive any FB during their EM clerkship. Of the senior MS receiving FB, 80.4% reported receiving SFICP. Of these MS, 2.4% reported receiving SFICP during or at the conclusion of every clinical shift, 14.6% - most clinical shifts, 43.9% - some clinical shifts, and 39% of MS reported receiving SFICP during or at the conclusion of few clinical shifts. Overall no difference was noted in regards to the frequency of FB and SFICP reported by senior MS compared to that being provided by their supervising physicians (FAC and SR). 93.6% of senior MS felt that the FB they received was beneficial, and 94.1% felt that additional FB would be beneficial. 97% of supervising physicians felt that the FB they provide is beneficial, and 93.5% felt that additional FB would be beneficial. There was no difference identified in the frequency of FB and SFICP provided by academic (n=16) vs clinical FAC (n=9), male (n=24) vs female (n=9) physicians (FAC and SR), junior (n=12) vs senior FAC (n=13) (O5 years post residency training), or SR (n=8) vs FAC (n=25) as compared to that reported by senior MS. Conclusion: The majority of senior MS report receiving FB which included SFICP throughout their EM clerkship although many feel that additional FB would be beneficial. Most supervising physicians provide FB and SFICP to senior MS during their EM clerkship and many feel that additional FB would also be beneficial. Junior and senior academic FAC, clinical FAC, and SR appear to provide similar levels of FB and SFICP to senior MS during an EM clerkship. Additional research in this area is necessary to evaluate the type and effectiveness of FB and SFICP provided.
315
Dutch Emergency Department Patient Characteristics: Implications for an Emergency Medicine Residency Program
Elshove-Bolk J, Mencl F, van Rijswijck B, Weiss EM, Simons M, van Vugt A, Haraldsplass Diakonale Sykehus, Bergen, Norway; OLVG, Amsterdam, Netherlands; University of Maastricht, Maastricht, Netherlands; Vrije Universiteit van Amsterdam, Amsterdam, Netherlands; University of Nijmegen, Nijmegen, Netherlands
Study Objectives: Emergency medicine (EM) does not yet exist as a specialty in the Netherlands, and there is no consensus on the scope of practice for future emergency physicians, nor a defined EM curriculum. We set out to study ED patient characteristics at a busy level 2 trauma center in Amsterdam in order to gain insight into the practice of EM and determine any implications for EM training in the Netherlands.
Volume 46, no. 3 : September 2005
312
Emergency Physicians and the Neurologic Examination
Nagurney JT, Resnick JB, Gatha N, Binder W, Filbin M, Borczuk P, Brown DF, Swap C, Parry B, Chang Y, Massachusetts General Hospital, Boston, MA; Harvard Affiliated Emergency Medicine Residency, Boston, MA; Albany Medical College, Albany, NY; University of California at San Francisco School of Medicine, San Francisco, CA
Study Objectives: Because the neurologic examination (Neurexam) contributes to EP ordering of neuroimaging, we measured its test characteristics as performed by ED faculty and non-neurology residents on ED patients. Methods: We conducted a prospective observational study in the ED of a 76,000-visit university hospital. Care is provided by PGY 1-4 residents in EM, IM and surgery supervised by board-certified or eligible faculty EPs with 1-25 years of experience. Neuromedical and neurosurgical consults are performed by PGY 2 neuroresidents. Providers of adults who received CT or MRI of the brain and a neuromedical consult were studied. Enrollment occurred during all weekdays from July-Oct 2004. The Neurexam of ED providers was abstracted from medical records and coded as normal or focally or globally abnormal. Test characteristics were determined for this Neurexam using the neurologist’s Neurexam as the criterion standard. Results: 113 patients were enrolled with a median age of 57 years; 53% were male. The presenting complaints were a focal neurological deficit (37%), headache (12%) and trauma (12%). Overall, 43% of patients had a prior neurologic history and 50% of neuroimages were acutely abnormal. ED attendings (23) documented Neurexams for 101 patients, and 36 residents for 91. For attendings, the sens of the exam was 79% (95% CI: 68-88%) and the spec was 83% (95% CI: 63-95%). For residents, these figures were 82% (95% CI: 70-90%) and 69% (95% CI: 48-86%) respectively. Among the 61 Neurexams found abnormal by the neurologists, the resident and attending agreed on 58 (95%), but agreed on only 65% of the 20 Neurexams found normal. by the neurologist. Conclusion: The clinical Neurexam as performed on ED patients by faculty EPs and residents has reasonable sens and spec when compared to that of a Neurexam performed by a neurologist. Further analysis of false positive and false negative Neurexams may contribute to medical education and to cost-effectiveness.
313
New Education Delivery System Plays Vital Role in Getting Patients to Emergency Department Within ‘Golden Hour’
Crews MG, Holbrook SE, DeKalb Fire and Rescue Services, Decatur, GA; DeKalb Medical Center, Decatur, GA
Study Objectives: In 2004, a web-based learning system was implemented. This study is designed to determine the effect of web-based learning systems on delivery time to Emergency Departments of patients in an urban setting that meet the Anatomic and Physiologic Criteria components of Trauma Triage Criteria. Methods: This retrospective study was conducted in conjunction with an audit of the eCampus learning system to determine the effectiveness of the system after the first 6 months of operation. A ‘Trauma Triage Criteria’ module consisting of one contact hour was developed and delivered to employees of DeKalb Fire and Rescue Services. The course described the trauma system in great detail, the trauma triage criteria, and it emphasizes the importance of the ‘golden hour’ as well as early communication with hospitals receiving patients meeting these criteria. Pre-hospital patient contact time (time from dispatch to hospital delivery) was measured. Results: In the months preceding the delivery of the Trauma Triage Criteria in-service, the Department saw an average Patient Contact Time of 47.38 minutes.
S88 Annals of Emergency Medicine
The months following the Trauma Triage in-service showed an average Patient Contact Time of 41.39 minutes. This downward trend continues into 2005. Conclusion: The delivery of this web-based training coupled with highly effective system guidelines and managerial practices has led to a system of greater accountability and has resulted in an immediate and sustained drop in Pre-hospital patient contact times for those patients meeting Trauma Triage Criteria. This allows delivery of patients to Emergency Departments with more time left in their ‘‘Golden Hour’’, and therefore they have a better chance to survive their injuries. This low cost and effective learning system can easily be adapted for use in busy, urban Fire/Rescue systems.
314
How Often Do Senior Medical Students Receive Formative Feedback During an Emergency Medicine Clerkship
Wald DA, Barrett J, Temple University School of Medicine, Philadelphia, PA
Study Objectives: Formative feedback (FB) is an essential part of the medical education process. In the setting of clinical medical education, FB refers to information describing a students’ performance in a given activity that is intended to guide their future performance in that same or related activity. However, no data is available on how often senior medical students (MS) receive FB and suggestions for improving clinical performance (SFICP) during an emergency medicine (EM) clerkship. This study sought to determine how often senior MS receive FB and SFICP during an EM clerkship and whether there are any differences in the frequency of FB received by senior MS as compared to that provided by supervising physicians. Methods: From July - December 2004, all 53 students rotating through a busy urban emergency department were surveyed at the completion of their EM clerkship about receiving FB and SFICP from supervising physicians. In the fall of 2004, all 25 EM faculty (FAC) and 8 senior EM residents (SR) were also surveyed about providing FB and SFICP to senior MS. Results: 51 of 53 senior MS (96.2%) completed the survey. All FAC and SR completed the survey. 5.9% of senior MS reported receiving FB during or at the conclusion of every clinical shift, 31.4% - most clinical shifts, 35.3% - some clinical shifts, 23.5% - few clinical shifts, and 3.9% of senior MS reported that they did not receive any FB during their EM clerkship. Of the senior MS receiving FB, 80.4% reported receiving SFICP. Of these MS, 2.4% reported receiving SFICP during or at the conclusion of every clinical shift, 14.6% - most clinical shifts, 43.9% - some clinical shifts, and 39% of MS reported receiving SFICP during or at the conclusion of few clinical shifts. Overall no difference was noted in regards to the frequency of FB and SFICP reported by senior MS compared to that being provided by their supervising physicians (FAC and SR). 93.6% of senior MS felt that the FB they received was beneficial, and 94.1% felt that additional FB would be beneficial. 97% of supervising physicians felt that the FB they provide is beneficial, and 93.5% felt that additional FB would be beneficial. There was no difference identified in the frequency of FB and SFICP provided by academic (n=16) vs clinical FAC (n=9), male (n=24) vs female (n=9) physicians (FAC and SR), junior (n=12) vs senior FAC (n=13) (O5 years post residency training), or SR (n=8) vs FAC (n=25) as compared to that reported by senior MS. Conclusion: The majority of senior MS report receiving FB which included SFICP throughout their EM clerkship although many feel that additional FB would be beneficial. Most supervising physicians provide FB and SFICP to senior MS during their EM clerkship and many feel that additional FB would also be beneficial. Junior and senior academic FAC, clinical FAC, and SR appear to provide similar levels of FB and SFICP to senior MS during an EM clerkship. Additional research in this area is necessary to evaluate the type and effectiveness of FB and SFICP provided.
315
Dutch Emergency Department Patient Characteristics: Implications for an Emergency Medicine Residency Program
Elshove-Bolk J, Mencl F, van Rijswijck B, Weiss EM, Simons M, van Vugt A, Haraldsplass Diakonale Sykehus, Bergen, Norway; OLVG, Amsterdam, Netherlands; University of Maastricht, Maastricht, Netherlands; Vrije Universiteit van Amsterdam, Amsterdam, Netherlands; University of Nijmegen, Nijmegen, Netherlands
Study Objectives: Emergency medicine (EM) does not yet exist as a specialty in the Netherlands, and there is no consensus on the scope of practice for future emergency physicians, nor a defined EM curriculum. We set out to study ED patient characteristics at a busy level 2 trauma center in Amsterdam in order to gain insight into the practice of EM and determine any implications for EM training in the Netherlands.
Volume 46, no. 3 : September 2005