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Enhancing Ultrasound Education through Volunteer Participation in Cardiac Screening
Research Forum Abstracts
382
Enhancing Ultrasound Education through Volunteer Participation in Cardiac Screening
Shieh M, Aish B, Mohan U, Klaus S, English C, Hata S, Fox JC/Beth Israel Medical Center, New York, NY; University of California, Irvine, Irvine, CA
Study Objectives: To develop medical student sonography skills through volunteer involvement in a cardiac screening of local athletes for hypertrophic cardiomyopathy. Methods: University of California, Irvine medical students were recruited and trained to obtain cardiac ultrasound images to detect hypertrophic cardiomyopathy (HCM) in local high school athletes. HCM ultrasound training involved watching an instructional video and up to two hours of supervised, hands-on ultrasound use. Students had unlimited access to an ultrasound machine for non-supervised practice. Ten Orange County, California high schools or junior colleges hosted the ultrasound cardiac screening team of 5-12 medical students and 1-3 supervising physicians as part of student athlete physical events. An average of 120 student athletes were scanned during each 4-hour screening. For each athlete, a medical student obtained 2-second video clips of parasternal long and parasternal short cardiac views. From the parasternal short view, apical to the mitral valve, the muscular ventricular septum and the left ventricular wall were monitored in motion mode (m-mode) and were measured in systole and diastole on a still m-mode image. The recorded ultrasound videos and images were reviewed by a pediatric cardiologist after the screening. Medical students were asked to complete a brief survey about their participation. Results: Twenty-five medical student volunteers and five physicians obtained cardiac ultrasound data for 1200 young athletes in Orange County, CA over a fourmonth period. Incidence of findings is pending final review by the research team pediatric cardiologist, who determined 67-74% of student-performed cardiac scans adequate for HCM assessment. Students reported increased confidence in obtaining specific cardiac views quickly, utilizing extensive features of the ultrasound machine, and teaching the screening process to other students. Conclusions: Student participation in public ultrasound screening provides a public service and enhances student skills and confidence.
383
A Descriptive Analysis of the Evaluative Components on the Standard Letter of Recommendation in Emeregency Medicine
Grall K, Hiller K, Stoneking L/University of Arizona, Tucson, AZ
Study Objectives: The standard letter of recommendation in emergency medicine (SLOR) was developed in an effort to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this
study was to describe and characterize the distribution of categorical variables included on the SLOR for students applying to the University of Arizona emergency medicine residency programs in order to better understand the scoring tendencies of letter writers. Methods: We performed a retrospective review of all SLORs written on behalf of all students applying to the three emergency medicine residency programs in the University of Arizona Health Network (ie, the University Campus program, the South Campus program and the Emergency Medicine/Pediatrics combined program) in 2012. All variables for “Qualifications for Emergency Medicine” and “Global Assessment” on the SLOR were analyzed. Results: A total of 1457 SLORs were submitted and reviewed, representing 26.7% of the total number of Electronic Residency Application Service (ERAS) applicants for the academic year 2012. Letter writers were more likely to use the highest/most desirable category on “Qualifications for EM” variables (50.7% of all responses) and to use the second highest category on Global Assessments (43.8% of all responses). For 4-point scale variables, 91% of all responses were in one of the top two ratings and for 3-point scale variables, 94.6% were in one of the top two ratings. Overall, the lowest/least desirable categories for ratings were used less than 2% of the time. Conclusions: SLOR letter writers do not proportionately use the full spectrum of categories for each variable. Despite the attempt to discourage grade inflation, nearly all of the variable responses on the SLOR are in the top two categories. Writers use the lowest categories less than 2% of the time. Program directors should consider these tendencies of the letter writers when reviewing SLORs of potential applicants to their programs.
384
Factors Influencing Physician Determination of Code Status in the Emergency Department
Noonan JM, Goett RR, Haar RJ/St Lukes Roosevelt Hospital, New York, NY
Study Objectives: Emergency physicians frequently manage critically ill patients and are expected to determine code status, advanced directives and the level of care expected by patients and families accurately and efficiently. Research has shown that advanced directives and code status do alter treatment decisions in the emergency department (ED), but many emergency physicians do not feel comfortable having this discussion despite research showing no resistance from patients or their families. This may indicate that systemic and educational factors influence an emergency physicians comfort level and ability to determine code status in the ED. This study aims to identify specific barriers to this process. Methods: All 82 emergency physicians employed by a 2-hospital urban academic ED were recruited to complete a survey via email. Eighty-nine percent of physicians surveyed participated, including 36 (86%) attendings and 37 (93%) residents. The survey asked emergency physicians to identify their level of training, sources they routinely check and consider valid in determining a patient’s code status, barriers to the process, comfort with the paperwork, and level of formal
Table 1. Indicators and Risk Factors for 30-Day Survival* 30-Day Survival
Total Mean Age (SD) Male Female African American Witnessed Arrest Bystander CPR AED Applied EMS Defibrillation Initial Rhythm VF/VT PEA Asystole ROSC
Yes
%
No
%
Total
404 58.7 (16.0) 224 180 229 123 64 117 44
8.56
81.1
9.98 9.06 10.3 9.17 13.5 9.07 10.3
3,827 64.5(16.9) 2,020 1,807 1,985 1,219 411 1,173 385
90.02 90.94 89.66 90.83 86.53 90.93 89.74
4,719 4,719 2,244 1,987 2,214 1,342 475 1,290 429
20 95 111 289
13.1 10.5 6.69 33.1
133 809 1,548 584
86.93 89.49 93.31 66.9
153 904 1,659 873
p/OR (CI) <0.0001 1.11 (0.91-1.36) 1.21 0.94 1.56 0.92 1.09 1.45 1.15 0.58 13.95
(0.99-1.50) (0.75-1.17) (1.18-2.08) (0.74-1.16) (0.78-1.51) (0.89-2.34) (0.90-1.46) (0.44-0.70) (11.05-17.62)
*total values vary secondary to unknown data
Volume 62, no. 4s : October 2013
Annals of Emergency Medicine S137
382
Enhancing Ultrasound Education through Volunteer Participation in Cardiac Screening
Shieh M, Aish B, Mohan U, Klaus S, English C, Hata S, Fox JC/Beth Israel Medical Center, New York, NY; University of California, Irvine, Irvine, CA
Study Objectives: To develop medical student sonography skills through volunteer involvement in a cardiac screening of local athletes for hypertrophic cardiomyopathy. Methods: University of California, Irvine medical students were recruited and trained to obtain cardiac ultrasound images to detect hypertrophic cardiomyopathy (HCM) in local high school athletes. HCM ultrasound training involved watching an instructional video and up to two hours of supervised, hands-on ultrasound use. Students had unlimited access to an ultrasound machine for non-supervised practice. Ten Orange County, California high schools or junior colleges hosted the ultrasound cardiac screening team of 5-12 medical students and 1-3 supervising physicians as part of student athlete physical events. An average of 120 student athletes were scanned during each 4-hour screening. For each athlete, a medical student obtained 2-second video clips of parasternal long and parasternal short cardiac views. From the parasternal short view, apical to the mitral valve, the muscular ventricular septum and the left ventricular wall were monitored in motion mode (m-mode) and were measured in systole and diastole on a still m-mode image. The recorded ultrasound videos and images were reviewed by a pediatric cardiologist after the screening. Medical students were asked to complete a brief survey about their participation. Results: Twenty-five medical student volunteers and five physicians obtained cardiac ultrasound data for 1200 young athletes in Orange County, CA over a fourmonth period. Incidence of findings is pending final review by the research team pediatric cardiologist, who determined 67-74% of student-performed cardiac scans adequate for HCM assessment. Students reported increased confidence in obtaining specific cardiac views quickly, utilizing extensive features of the ultrasound machine, and teaching the screening process to other students. Conclusions: Student participation in public ultrasound screening provides a public service and enhances student skills and confidence.
383
A Descriptive Analysis of the Evaluative Components on the Standard Letter of Recommendation in Emeregency Medicine
Grall K, Hiller K, Stoneking L/University of Arizona, Tucson, AZ
Study Objectives: The standard letter of recommendation in emergency medicine (SLOR) was developed in an effort to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this
study was to describe and characterize the distribution of categorical variables included on the SLOR for students applying to the University of Arizona emergency medicine residency programs in order to better understand the scoring tendencies of letter writers. Methods: We performed a retrospective review of all SLORs written on behalf of all students applying to the three emergency medicine residency programs in the University of Arizona Health Network (ie, the University Campus program, the South Campus program and the Emergency Medicine/Pediatrics combined program) in 2012. All variables for “Qualifications for Emergency Medicine” and “Global Assessment” on the SLOR were analyzed. Results: A total of 1457 SLORs were submitted and reviewed, representing 26.7% of the total number of Electronic Residency Application Service (ERAS) applicants for the academic year 2012. Letter writers were more likely to use the highest/most desirable category on “Qualifications for EM” variables (50.7% of all responses) and to use the second highest category on Global Assessments (43.8% of all responses). For 4-point scale variables, 91% of all responses were in one of the top two ratings and for 3-point scale variables, 94.6% were in one of the top two ratings. Overall, the lowest/least desirable categories for ratings were used less than 2% of the time. Conclusions: SLOR letter writers do not proportionately use the full spectrum of categories for each variable. Despite the attempt to discourage grade inflation, nearly all of the variable responses on the SLOR are in the top two categories. Writers use the lowest categories less than 2% of the time. Program directors should consider these tendencies of the letter writers when reviewing SLORs of potential applicants to their programs.
384
Factors Influencing Physician Determination of Code Status in the Emergency Department
Noonan JM, Goett RR, Haar RJ/St Lukes Roosevelt Hospital, New York, NY
Study Objectives: Emergency physicians frequently manage critically ill patients and are expected to determine code status, advanced directives and the level of care expected by patients and families accurately and efficiently. Research has shown that advanced directives and code status do alter treatment decisions in the emergency department (ED), but many emergency physicians do not feel comfortable having this discussion despite research showing no resistance from patients or their families. This may indicate that systemic and educational factors influence an emergency physicians comfort level and ability to determine code status in the ED. This study aims to identify specific barriers to this process. Methods: All 82 emergency physicians employed by a 2-hospital urban academic ED were recruited to complete a survey via email. Eighty-nine percent of physicians surveyed participated, including 36 (86%) attendings and 37 (93%) residents. The survey asked emergency physicians to identify their level of training, sources they routinely check and consider valid in determining a patient’s code status, barriers to the process, comfort with the paperwork, and level of formal
Table 1. Indicators and Risk Factors for 30-Day Survival* 30-Day Survival
Total Mean Age (SD) Male Female African American Witnessed Arrest Bystander CPR AED Applied EMS Defibrillation Initial Rhythm VF/VT PEA Asystole ROSC
Yes
%
No
%
Total
404 58.7 (16.0) 224 180 229 123 64 117 44
8.56
81.1
9.98 9.06 10.3 9.17 13.5 9.07 10.3
3,827 64.5(16.9) 2,020 1,807 1,985 1,219 411 1,173 385
90.02 90.94 89.66 90.83 86.53 90.93 89.74
4,719 4,719 2,244 1,987 2,214 1,342 475 1,290 429
20 95 111 289
13.1 10.5 6.69 33.1
133 809 1,548 584
86.93 89.49 93.31 66.9
153 904 1,659 873
p/OR (CI) <0.0001 1.11 (0.91-1.36) 1.21 0.94 1.56 0.92 1.09 1.45 1.15 0.58 13.95
(0.99-1.50) (0.75-1.17) (1.18-2.08) (0.74-1.16) (0.78-1.51) (0.89-2.34) (0.90-1.46) (0.44-0.70) (11.05-17.62)
*total values vary secondary to unknown data
Volume 62, no. 4s : October 2013
Annals of Emergency Medicine S137