- Email: [email protected]
PGY-Specific Conference in Emergency Medicine
CORD Abstracts
16
Environmental Emergencies Amazing Race
Rodriguez N, Ebinger A, Oksuita K, Niewold J, Tupesis J/University of Wisconsin School of Medicine and Public Health, Middleton, WI
Introduction: Environmental injuries occur in various types of settings. The exposure an emergency medicine resident has to these conditions varies based on geographic location and weather, yet it remains an important skill set to learn. The ability to learn and practice these skills on realistic scenarios will improve understanding and retention of this information. Educational Objectives: 1. Construct a venue through which residents can gain exposure to environmental injuries. 2. Evaluate and promote medical knowledge of environmental injuries. 3. Demonstrate acute diagnostic and management skills of environmental injuries. Curricular Design: As part of our continual efforts to evaluate our residency curriculum, a group sought to improve the delivery of medical knowledge and skills acquisition when it relates to environmental injuries. This group identified 12 specific topics to address. Using the framework of the TV show Amazing Race, the group developed an outdoor obstacle course for EM resident teams. Each station consisted of a clinical scenario, mandatory tasks/questions, and bonus tasks/questions. In addition, teams participated in walking, running, biking, and swimming between or at stations. Times and scores were tabulated for each team. Subsequently, each faculty station leader ran all teams through each station and solved the tasks/questions for the given station. Impact/Effectiveness: Based on formal evaluations, residents reported this curriculum as an excellent tool for evaluating medical knowledge of environmental injuries while promoting retention of the material as opposed to didactic sessions. Residents reported being exposed to injuries they would normally not see, given geography and clinical setting.
17
Mock Court: A Novel Curriculum Element to Teach Chart Review, Improved Care, and Better Documentation
Shanks R, Snyder G/University of North Carolina at Chapel Hill, Chapel Hill, NC
Introduction: Chart review and morbidity and mortality conferences are important opportunities for interactive reflection in residency training. These activities allow for reflection on quality of care, systems-level delivery of care, and quality of documentation. Such concepts are critical to the training of future emergency physicians. Educational Objective: We have established a novel curriculum component in an effort to further teach chart review. Termed “Mock Court,” this process involves resident-led discussion in a simulated court environment of selected cases. Curricular Design: Each case is selected by the curriculum team. The documentation presented involves only the initial visit. Cases are not typically associated with a poor outcome as they are presented in our mortality and morbidity conference. Rather, a second factitious visit or outcome is engineered into the case. This final outcome is based on common diagnoses associated with the initial chief complaint. Residents are assigned to either the prosecution or defense and given the initial documentation and final outcome prior to the session. The case is then presented by each team during our weekly didactics. A member of our leadership moderates (ie, judges) this discussion. At the end of the session, audience members are asked to comment on the care, documentation, and finally on their judgment of the case to the prosecution or defense. Impact: Addition of Mock Court has increased the quality of our didactic instruction. This approach leads to lively debate and resident engagement. It provides a unique opportunity for faculty to comment on documentation and quality of care. Although the focus is to teach chart review and improved quality and delivery of care, this format also contributes to discussion of legally defensible documentation of quality care and the vulnerability of a provider who has a patient with a bad outcome coupled with inadequate documentation.
18
PGY Specific Conference in Emergency Medicine Lucas R, Roche C, Bonifce K/Washington University, Washington, DC
Background: With the requirement to provide 5 hours of didactic content per week, EM programs often provide lecture-type content to all residents at all levels in one setting. This is economical from a program and faculty standpoint but does not address the needs of different learners at different postgraduate year (PGY) levels. This approach is also more challenging for discussion and interaction between learners and faculty.
S172 Annals of Emergency Medicine
Objectives: Our objective was to create a curriculum of class-specific learning modules with goals to be appropriate to each PGY level of training and delivered in a small group format. Curricular Design: We reviewed our current policy on resident advancement that gave a narrative description of clinical expectations at each PGY level and specific competency objectives for yearly promotion. We cross-referenced this to our topic-based conference curriculum. Based on that, we developed 48 educational sessions to be delivered monthly to each PGY level. Sample modules include “A sensible approach to abdominal pain” ( PGY-1), “Strategic test ordering in the ED” (PGY-2), “Advanced airway techniques” (PGY-3), and “ED billing and coding” (PGY-4). All modules were faculty led and delivered as case-based learning, as small group discussion, or in the simulation laboratory. Faculty members were recruited to teach each module and prepped with learning objectives and suggested content. Impact: At our annual program review, PGY-specific learning was highly rated by both residents and faculty. Residents found benefit in increased faculty participation and the small group format. Although total faculty teaching time increased, faculty thought participation was less onerous than preparing a large, “grand rounds” type of lecture and also found the small group format rewarding. After implementation, we adjusted topics based on educational needs uncovered in the resident and program review process, creating an educational improvement loop in our program.
19
Teaching the Pediatric Assessment Triangle Using Online Video Cases
Hansen M, Spiro D/Oregon Health and Science University, Portland, OR
Introduction: Critically ill children are rarely seen by most providers during training, which creates the potential for a knowledge gap in patient assessment. The pediatric assessment triangle (PAT) is the structural framework used in pediatric advanced live support (PALS) to teach assessment based on appearance, work of breathing, and circulation. One study in revision demonstrates that many medical students and interns are not able to differentiate upper and lower airway obstruction and identify severity of respiratory distress in children. Another ongoing out-of-hospital study demonstrates that differentiating sick versus not sick in children is a potential source of errors. Patient videos can make these infrequent scenarios accessible to many learners. Educational Objectives: Learners will more accurately identify severity of illness in children in the domains of appearance, work of breathing, and circulation, using the descriptors mild, moderate, or severe. Curricular Design: We selected the PAT for our module as it is the most widely used and standardized framework. The module is based on 8 video cases from the pediatric emergency department. It is expected to take 1 hour to complete. Learners see patient videos and are asked to assess the overall illness severity, as well as severity of appearance, work of breathing, and circulation. In addition, learners are prompted to click on areas of the screen where particular physical findings are seen. Learners then see their scores and the correct answers with synoptic text and watch the videos again for emphasis. This is a work in progress and we continue to add cases. Effectiveness: We believe that these interactive online video cases will help learners improve pediatric assessment skills. We present a novel way to teach patient assessment that is not well taught in other methods, including simulation. We will evaluate effectiveness using video case pre and post tests.
20
The July Course: A Curricular Model for Transitioning Medical Students to Residents
Conrad C, Ahn C, Garra G/Stony Brook University Medical Center, Stony Brook, NY
Introduction: Transitioning medical students to residents is a challenging process. The change is abrupt, and one which many students are poorly equipped to navigate. The role residency programs take in educating and preparing interns to perform competently during the first weeks of graduate medical education varies widely. Educational Objective: The objective for the first rotation of our residency (July Course) is to provide practical, uniform preparation for clinical duties in the ED for interns arriving at residency training with varying levels of aptitude. Curricular Design: The July Course consists of 4 principal components: readings, lectures, procedure training, and clinical experience. Each day is divided into morning lecture/testing and afternoon skill laboratories. Reading assignments and weekly quizzes are derived from “Emergency Medicine: An Approach to Clinical Problem-Solving.” Lectures addressing critical conditions listed in the “Model of the Clinical Practice of Emergency Medicine” are given by EM faculty. Senior residents and faculty provide
Volume 62, no. 5 : November 2013
16
Environmental Emergencies Amazing Race
Rodriguez N, Ebinger A, Oksuita K, Niewold J, Tupesis J/University of Wisconsin School of Medicine and Public Health, Middleton, WI
Introduction: Environmental injuries occur in various types of settings. The exposure an emergency medicine resident has to these conditions varies based on geographic location and weather, yet it remains an important skill set to learn. The ability to learn and practice these skills on realistic scenarios will improve understanding and retention of this information. Educational Objectives: 1. Construct a venue through which residents can gain exposure to environmental injuries. 2. Evaluate and promote medical knowledge of environmental injuries. 3. Demonstrate acute diagnostic and management skills of environmental injuries. Curricular Design: As part of our continual efforts to evaluate our residency curriculum, a group sought to improve the delivery of medical knowledge and skills acquisition when it relates to environmental injuries. This group identified 12 specific topics to address. Using the framework of the TV show Amazing Race, the group developed an outdoor obstacle course for EM resident teams. Each station consisted of a clinical scenario, mandatory tasks/questions, and bonus tasks/questions. In addition, teams participated in walking, running, biking, and swimming between or at stations. Times and scores were tabulated for each team. Subsequently, each faculty station leader ran all teams through each station and solved the tasks/questions for the given station. Impact/Effectiveness: Based on formal evaluations, residents reported this curriculum as an excellent tool for evaluating medical knowledge of environmental injuries while promoting retention of the material as opposed to didactic sessions. Residents reported being exposed to injuries they would normally not see, given geography and clinical setting.
17
Mock Court: A Novel Curriculum Element to Teach Chart Review, Improved Care, and Better Documentation
Shanks R, Snyder G/University of North Carolina at Chapel Hill, Chapel Hill, NC
Introduction: Chart review and morbidity and mortality conferences are important opportunities for interactive reflection in residency training. These activities allow for reflection on quality of care, systems-level delivery of care, and quality of documentation. Such concepts are critical to the training of future emergency physicians. Educational Objective: We have established a novel curriculum component in an effort to further teach chart review. Termed “Mock Court,” this process involves resident-led discussion in a simulated court environment of selected cases. Curricular Design: Each case is selected by the curriculum team. The documentation presented involves only the initial visit. Cases are not typically associated with a poor outcome as they are presented in our mortality and morbidity conference. Rather, a second factitious visit or outcome is engineered into the case. This final outcome is based on common diagnoses associated with the initial chief complaint. Residents are assigned to either the prosecution or defense and given the initial documentation and final outcome prior to the session. The case is then presented by each team during our weekly didactics. A member of our leadership moderates (ie, judges) this discussion. At the end of the session, audience members are asked to comment on the care, documentation, and finally on their judgment of the case to the prosecution or defense. Impact: Addition of Mock Court has increased the quality of our didactic instruction. This approach leads to lively debate and resident engagement. It provides a unique opportunity for faculty to comment on documentation and quality of care. Although the focus is to teach chart review and improved quality and delivery of care, this format also contributes to discussion of legally defensible documentation of quality care and the vulnerability of a provider who has a patient with a bad outcome coupled with inadequate documentation.
18
PGY Specific Conference in Emergency Medicine Lucas R, Roche C, Bonifce K/Washington University, Washington, DC
Background: With the requirement to provide 5 hours of didactic content per week, EM programs often provide lecture-type content to all residents at all levels in one setting. This is economical from a program and faculty standpoint but does not address the needs of different learners at different postgraduate year (PGY) levels. This approach is also more challenging for discussion and interaction between learners and faculty.
S172 Annals of Emergency Medicine
Objectives: Our objective was to create a curriculum of class-specific learning modules with goals to be appropriate to each PGY level of training and delivered in a small group format. Curricular Design: We reviewed our current policy on resident advancement that gave a narrative description of clinical expectations at each PGY level and specific competency objectives for yearly promotion. We cross-referenced this to our topic-based conference curriculum. Based on that, we developed 48 educational sessions to be delivered monthly to each PGY level. Sample modules include “A sensible approach to abdominal pain” ( PGY-1), “Strategic test ordering in the ED” (PGY-2), “Advanced airway techniques” (PGY-3), and “ED billing and coding” (PGY-4). All modules were faculty led and delivered as case-based learning, as small group discussion, or in the simulation laboratory. Faculty members were recruited to teach each module and prepped with learning objectives and suggested content. Impact: At our annual program review, PGY-specific learning was highly rated by both residents and faculty. Residents found benefit in increased faculty participation and the small group format. Although total faculty teaching time increased, faculty thought participation was less onerous than preparing a large, “grand rounds” type of lecture and also found the small group format rewarding. After implementation, we adjusted topics based on educational needs uncovered in the resident and program review process, creating an educational improvement loop in our program.
19
Teaching the Pediatric Assessment Triangle Using Online Video Cases
Hansen M, Spiro D/Oregon Health and Science University, Portland, OR
Introduction: Critically ill children are rarely seen by most providers during training, which creates the potential for a knowledge gap in patient assessment. The pediatric assessment triangle (PAT) is the structural framework used in pediatric advanced live support (PALS) to teach assessment based on appearance, work of breathing, and circulation. One study in revision demonstrates that many medical students and interns are not able to differentiate upper and lower airway obstruction and identify severity of respiratory distress in children. Another ongoing out-of-hospital study demonstrates that differentiating sick versus not sick in children is a potential source of errors. Patient videos can make these infrequent scenarios accessible to many learners. Educational Objectives: Learners will more accurately identify severity of illness in children in the domains of appearance, work of breathing, and circulation, using the descriptors mild, moderate, or severe. Curricular Design: We selected the PAT for our module as it is the most widely used and standardized framework. The module is based on 8 video cases from the pediatric emergency department. It is expected to take 1 hour to complete. Learners see patient videos and are asked to assess the overall illness severity, as well as severity of appearance, work of breathing, and circulation. In addition, learners are prompted to click on areas of the screen where particular physical findings are seen. Learners then see their scores and the correct answers with synoptic text and watch the videos again for emphasis. This is a work in progress and we continue to add cases. Effectiveness: We believe that these interactive online video cases will help learners improve pediatric assessment skills. We present a novel way to teach patient assessment that is not well taught in other methods, including simulation. We will evaluate effectiveness using video case pre and post tests.
20
The July Course: A Curricular Model for Transitioning Medical Students to Residents
Conrad C, Ahn C, Garra G/Stony Brook University Medical Center, Stony Brook, NY
Introduction: Transitioning medical students to residents is a challenging process. The change is abrupt, and one which many students are poorly equipped to navigate. The role residency programs take in educating and preparing interns to perform competently during the first weeks of graduate medical education varies widely. Educational Objective: The objective for the first rotation of our residency (July Course) is to provide practical, uniform preparation for clinical duties in the ED for interns arriving at residency training with varying levels of aptitude. Curricular Design: The July Course consists of 4 principal components: readings, lectures, procedure training, and clinical experience. Each day is divided into morning lecture/testing and afternoon skill laboratories. Reading assignments and weekly quizzes are derived from “Emergency Medicine: An Approach to Clinical Problem-Solving.” Lectures addressing critical conditions listed in the “Model of the Clinical Practice of Emergency Medicine” are given by EM faculty. Senior residents and faculty provide
Volume 62, no. 5 : November 2013