- Email: [email protected]
84 Do Reflective Students Learn More in the Emergency Department?
Research Forum Abstracts Conclusion: By functioning as part of a RRT, EM residents have increased exposure to resuscitation and critical care procedures.
83
Using Standardized Patients to Evaluate Medical Students’ Evidence-Based Medicine Skills
Amini R, Hernandez NC, Keim SM, Gordon PR/University of Arizona, Tucson, AZ
Study Objectives: To determine the effectiveness of an Evidence-Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution. Methods: This was a single-center prospective cross-sectional study. As part of the eight-station OSCE examination, the investigators developed and implemented a new 25-minute EBM OSCE station with the goal of evaluating students’ ability to search for a relevant article, appraise the article, define and discuss the concept of relative risk and number needed to treat with regards to the administration of dexamethasone for rebound migraines. The OSCE case involved a highly educated patient with a history of recurrent debilitating migraines who has brought eight specific questions regarding the use of steroids for migraine headaches. Students were provided computer stations equipped to record a log of the searches performed. Results: One hundred four third-year medical students participated in this study. The average number of search tools used by the students was 4 (SD¼ 2). A total of 896 searches were performed by 104 students. The two most commonly used Web sites were uptodate.com and google.com. Sixty-nine percent (95% CI, 60% to 78%) of students were able to find a meta-analysis regarding the use of dexamethasone for the prevention of rebound migraines. Fifty-two percent of students were able to explain that patients who took dexamethasone had a moderate RR (0.68 - 0.78) of having a recurrent migraine, and 71% of students were able to explain to the standardized patient that the NNT for dexamethasone was nine. Conclusion: Standardized patients were successfully used to evaluate medical student EBM skills during an OSCE.
84
Do Reflective Students Learn More in the Emergency Department?
Hu K, Leuthauser A, Chary M, Hexom B/Icahn School of Medicine at Mount Sinai, New York, NY
Study Objectives: Medical schools have begun to incorporate self-reflection exercises into their curricula. It is thought that these exercises help students master the material more deeply and perform better on exams. There are few data supporting this hypothesis. We evaluated the relationship between the degree of reflection after a student’s shift in an emergency department and that student’s final grade. Methods: We conducted a retrospective case series by analyzing the performance and reflective statements of 116 students who participated in an emergency medicine clerkship at two clinical sites from 2013-2014. After each shift, an attending emergency physician evaluated the student and the student could complete an optional reflection free text section. We extracted the text from those comments, removed stopwords, and lemmatized the remaining words. Stopwords are words that occur frequently and serve only a grammatical functions, such as “a, the, of.” We analyzed the correlation between a comprehensive exam grade and the fraction of reflections with at least one content word. We determined the most common words and pairs of adjacent words that students used to describe their reflections. We compared the median scores of those who wrote reflections more than half of the time with those who wrote reflections less than half of the time. Results: Of the 145 possible records, 116 were included for analysis. The other 29 were excluded as they were visiting students. The correlation between exam grade and the number of completed self-reflections was 0.32. The correlation between exam grade and the average number of words in each self-reflection was 0.21. The first correlation is significantly greater than 0 (P ¼ .03, t-test), but the second correlation is not (P ¼ .16, t-test). The median score of those who wrote reflections on more than half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (P ¼ .05, 2-sample KolmogorovSmirnov test).
S30 Annals of Emergency Medicine
Conclusion: Students who reflected more frequently scored more highly on a final written exam in an emergency medicine clerkship designed for fourth year medical students. The number of words in each reflection was not significantly correlated with exam performance. A more formal reflection program, perhaps including data from the clinical notes students write during their rotation, could help identify students struggling to master the content before they take the final exam.
85
Prevalence and Survival Impact of Bystander Cardiopulmonary Resuscitation in Sudden Cardiac Arrest Victims Treated by a Large, Urban Emergency Medical Services System in North America
Goodloe JM, Braithwaite SA, Arthur AO, Arthur E, Reed H/University of Oklahoma School of Community Medicine, Tulsa, OK; Office of the Medical Director, EMS System for Metropolitan Oklahoma City and Tulsa, Tulsa, OK
Study Objectives: Bystander cardiopulmonary resuscitation (CPR) is often cited as a contributor to neurologically intact survival from out of hospital sudden cardiac arrest (OOH SCA). Ardent efforts continue in hopes of training more laypersons in CPR, producing higher prevalence of bystander CPR in OOH SCA events, and realizing greater success in neurologically intact survival from cardiac arrest. This study’s purpose is to analyze demographics, prevalence and survival impact of bystander CPR in two large, urban metropolitan areas of North America. Methods: Database query and descriptive analysis utilizing a multiple-variable database designed for use by medical oversight in a large, urban emergency medical services (EMS) system in North America. The database contains demographic, clinical resuscitation, and outcomes variables on all OOH SCA victims with resuscitation initiated by the study EMS system from January 1, 1993 onward. This study’s cohort included all such OOH SCA victims from January 1, 1993 through December 31, 2013. Results: In the 21-year period, 20,567 resuscitations occurred. A bystander witnessed the arrest in 8,334 (40.5%) instances. Whether witnessed or not, bystander CPR was started in 7,028 (34.2%) of arrests. There was a downward trend of resuscitations being witnessed by bystanders from a high of 444/827 (53.7%) in 1995 to a low of 394/1232 (32.0%) in 2012. Despite this lower witnessing trend, there was an upward trend of bystander CPR being provided, from a low of 198/788 (25.1%) in 1994 to 472/1187 (39.8%) in 2012, with a high of 455/1028 (44.3%) in 2005. For 12,409 victims in which final outcomes were captured (mid-2000 and forward), bystander CPR was associated with an overall discharge from hospital rate of 694/4475 (15.5%). When compared to those surviving to hospital discharge without bystander CPR of 983/7934 (12.4%), P ¼ .000. Using bivariate logistic regression, OR ¼ 1.30 with 95% CI 1.17 1.44. Survival with a cerebral performance category score of 1 or 2 was enhanced by bystander CPR as well, bivariate logistic regression yielding OR ¼ 1.65 with 95% CI 1.40 - 1.94. Conclusion: In a particularly large cohort of OOH SCA victims, treated by the study EMS system in the over twenty years included, bystander CPR promotes neurologically intact survival with statistically significant results.
86
Recredentialing in Out-of-Hospital Care: Are We as Good as We Once Were?
Escott MEA, Case CM, Gleisberg GR, Anderson JL, Gillum LS, Kennedy KM/Baylor College of Medicine/EMS Collaborative Research Group, Houston, TX; Montgomery County Hospital District, Conroe, TX; Montgomery County Hospital District, Conroe, TX
Backgound: Credentialing of medical staff within the hospital environment is a required discipline. The National EMS Scope of Practice Model is based on the framework of education, certification, licensure and credentialing, which varies within each system in sophistication and formality. Recredentialing (RC) is the monitoring and periodic process that ensures professionals are re-evaluated to assure continued safe and effective patient care. Presently, a paucity of literature exists regarding RC within emergency medical services (EMS). Study Objective: We sought to determine if paramedics continued to meet the minimum requirements that were originally authorized under the license of the EMS medical director.
Volume 66, no. 4s : October 2015
83
Using Standardized Patients to Evaluate Medical Students’ Evidence-Based Medicine Skills
Amini R, Hernandez NC, Keim SM, Gordon PR/University of Arizona, Tucson, AZ
Study Objectives: To determine the effectiveness of an Evidence-Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution. Methods: This was a single-center prospective cross-sectional study. As part of the eight-station OSCE examination, the investigators developed and implemented a new 25-minute EBM OSCE station with the goal of evaluating students’ ability to search for a relevant article, appraise the article, define and discuss the concept of relative risk and number needed to treat with regards to the administration of dexamethasone for rebound migraines. The OSCE case involved a highly educated patient with a history of recurrent debilitating migraines who has brought eight specific questions regarding the use of steroids for migraine headaches. Students were provided computer stations equipped to record a log of the searches performed. Results: One hundred four third-year medical students participated in this study. The average number of search tools used by the students was 4 (SD¼ 2). A total of 896 searches were performed by 104 students. The two most commonly used Web sites were uptodate.com and google.com. Sixty-nine percent (95% CI, 60% to 78%) of students were able to find a meta-analysis regarding the use of dexamethasone for the prevention of rebound migraines. Fifty-two percent of students were able to explain that patients who took dexamethasone had a moderate RR (0.68 - 0.78) of having a recurrent migraine, and 71% of students were able to explain to the standardized patient that the NNT for dexamethasone was nine. Conclusion: Standardized patients were successfully used to evaluate medical student EBM skills during an OSCE.
84
Do Reflective Students Learn More in the Emergency Department?
Hu K, Leuthauser A, Chary M, Hexom B/Icahn School of Medicine at Mount Sinai, New York, NY
Study Objectives: Medical schools have begun to incorporate self-reflection exercises into their curricula. It is thought that these exercises help students master the material more deeply and perform better on exams. There are few data supporting this hypothesis. We evaluated the relationship between the degree of reflection after a student’s shift in an emergency department and that student’s final grade. Methods: We conducted a retrospective case series by analyzing the performance and reflective statements of 116 students who participated in an emergency medicine clerkship at two clinical sites from 2013-2014. After each shift, an attending emergency physician evaluated the student and the student could complete an optional reflection free text section. We extracted the text from those comments, removed stopwords, and lemmatized the remaining words. Stopwords are words that occur frequently and serve only a grammatical functions, such as “a, the, of.” We analyzed the correlation between a comprehensive exam grade and the fraction of reflections with at least one content word. We determined the most common words and pairs of adjacent words that students used to describe their reflections. We compared the median scores of those who wrote reflections more than half of the time with those who wrote reflections less than half of the time. Results: Of the 145 possible records, 116 were included for analysis. The other 29 were excluded as they were visiting students. The correlation between exam grade and the number of completed self-reflections was 0.32. The correlation between exam grade and the average number of words in each self-reflection was 0.21. The first correlation is significantly greater than 0 (P ¼ .03, t-test), but the second correlation is not (P ¼ .16, t-test). The median score of those who wrote reflections on more than half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (P ¼ .05, 2-sample KolmogorovSmirnov test).
S30 Annals of Emergency Medicine
Conclusion: Students who reflected more frequently scored more highly on a final written exam in an emergency medicine clerkship designed for fourth year medical students. The number of words in each reflection was not significantly correlated with exam performance. A more formal reflection program, perhaps including data from the clinical notes students write during their rotation, could help identify students struggling to master the content before they take the final exam.
85
Prevalence and Survival Impact of Bystander Cardiopulmonary Resuscitation in Sudden Cardiac Arrest Victims Treated by a Large, Urban Emergency Medical Services System in North America
Goodloe JM, Braithwaite SA, Arthur AO, Arthur E, Reed H/University of Oklahoma School of Community Medicine, Tulsa, OK; Office of the Medical Director, EMS System for Metropolitan Oklahoma City and Tulsa, Tulsa, OK
Study Objectives: Bystander cardiopulmonary resuscitation (CPR) is often cited as a contributor to neurologically intact survival from out of hospital sudden cardiac arrest (OOH SCA). Ardent efforts continue in hopes of training more laypersons in CPR, producing higher prevalence of bystander CPR in OOH SCA events, and realizing greater success in neurologically intact survival from cardiac arrest. This study’s purpose is to analyze demographics, prevalence and survival impact of bystander CPR in two large, urban metropolitan areas of North America. Methods: Database query and descriptive analysis utilizing a multiple-variable database designed for use by medical oversight in a large, urban emergency medical services (EMS) system in North America. The database contains demographic, clinical resuscitation, and outcomes variables on all OOH SCA victims with resuscitation initiated by the study EMS system from January 1, 1993 onward. This study’s cohort included all such OOH SCA victims from January 1, 1993 through December 31, 2013. Results: In the 21-year period, 20,567 resuscitations occurred. A bystander witnessed the arrest in 8,334 (40.5%) instances. Whether witnessed or not, bystander CPR was started in 7,028 (34.2%) of arrests. There was a downward trend of resuscitations being witnessed by bystanders from a high of 444/827 (53.7%) in 1995 to a low of 394/1232 (32.0%) in 2012. Despite this lower witnessing trend, there was an upward trend of bystander CPR being provided, from a low of 198/788 (25.1%) in 1994 to 472/1187 (39.8%) in 2012, with a high of 455/1028 (44.3%) in 2005. For 12,409 victims in which final outcomes were captured (mid-2000 and forward), bystander CPR was associated with an overall discharge from hospital rate of 694/4475 (15.5%). When compared to those surviving to hospital discharge without bystander CPR of 983/7934 (12.4%), P ¼ .000. Using bivariate logistic regression, OR ¼ 1.30 with 95% CI 1.17 1.44. Survival with a cerebral performance category score of 1 or 2 was enhanced by bystander CPR as well, bivariate logistic regression yielding OR ¼ 1.65 with 95% CI 1.40 - 1.94. Conclusion: In a particularly large cohort of OOH SCA victims, treated by the study EMS system in the over twenty years included, bystander CPR promotes neurologically intact survival with statistically significant results.
86
Recredentialing in Out-of-Hospital Care: Are We as Good as We Once Were?
Escott MEA, Case CM, Gleisberg GR, Anderson JL, Gillum LS, Kennedy KM/Baylor College of Medicine/EMS Collaborative Research Group, Houston, TX; Montgomery County Hospital District, Conroe, TX; Montgomery County Hospital District, Conroe, TX
Backgound: Credentialing of medical staff within the hospital environment is a required discipline. The National EMS Scope of Practice Model is based on the framework of education, certification, licensure and credentialing, which varies within each system in sophistication and formality. Recredentialing (RC) is the monitoring and periodic process that ensures professionals are re-evaluated to assure continued safe and effective patient care. Presently, a paucity of literature exists regarding RC within emergency medical services (EMS). Study Objective: We sought to determine if paramedics continued to meet the minimum requirements that were originally authorized under the license of the EMS medical director.
Volume 66, no. 4s : October 2015