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Race Medicine: A Novel Educational Experience for GME Learners
576
Letters to the Editor
injury and protection of athlete health supported by the International Olympic Committee. Paul Salmon’s contribution was funded by an ARC Future Fellowship (FT140100681). Natassia Goode, PhD Paul M. Salmon, PhD Centre for Human Factors and Sociotechnical Systems, Faculty of Arts and Business, School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia Michael G. Lenné, PhD Monash Injury Research Institute Monash University Melbourne, Victoria, Australia Caroline F. Finch, PhD Australian Centre for Research Into Injury in Sport and Its Prevention, Federation University Australia, Mount Helen, Victoria, Australia References 1. Salmon PM, Goode N, Lenné MG, Finch CF, Cassell E. Injury causation in the great outdoors: a systems analysis of led outdoor activity injury incidents. Accid Anal Prev. 2014;63:111–120. 2. Goode N, Salmon PM, Taylor N, Lenne M, Finch C. Bridging the research-practice gap: validity of a software tool designed to support systemic accident analysis by risk managers. Paper presented at: HCI International 2015; August 2–7, 2015; Los Angeles, California. 3. Salmon PM, Cornelissen M, Trotter MJ. Systems-based accident analysis methods: a comparison of Accimap, HFACS, and STAMP. Safety Sci. 2012;50:1158–1170. 4. Goode N, Finch CF, Cassell E, Lenné MG, Salmon PM. What would you like? Identifying the required characteristics of an industry-wide incident reporting and learning system for the led outdoor activity sector. AJOE. 2014;17:2–15. 5. Goode N, Salmon PM, Taylor N, Lenne M, Finch CF. A test of a systems theory-based incident coding taxonomy for risk managers. In: Ahram T, Karwowski W, Marek T, eds. Proceedings of the 5th International Conference on Applied Human Factors and Ergonomics AHFE 2014. July 19–23, 2014; Kraków, Poland. Krakow, Poland: The Printing House; 2014.
Race Medicine: A Novel Educational Experience for GME Learners To the Editor: Emergency medical services (EMS) and prehospital medicine are required areas of competency for
graduation from Emergency Medicine residency programs.1 Most programs use a traditional ride-along model in which residents spend time in EMS vehicles, participating in prehospital care, and assisting providers in the field.2,3 Although the standard model has primarily involved participation in urban 911 calls along with exposure to EMS agency administration, unconventional methods for achieving and meeting the core requirements have arisen to meet the challenge of innovating education to meet changing resident expectations.4 In addition, the growth of Accreditation Council for Graduate Medical Education (ACGME)–approved EMS fellowships has added to the learner pool, necessitating the exploration of new avenues and methodologies to achieve prehospital requirements. Race medicine is a relatively modern subset of medicine, encompassing event and mass-gathering medicine, wilderness medicine, expeditions medicine, sports medicine, EMS medicine, primary care, and emergency medicine. In many cases, races are held in remote and geographically interesting places over the course of several days. These events may involve large numbers of participants who de facto have been separated from the reach of emergency services infrastructure. Race physicians frequently encounter injury and illness related to both routine medical care and specific medical threats as a result of environment and activity.5 Furthermore, much of the medical equipment and processes used in an emergency department are unavailable, and physicians must use a heightened clinical acumen and fieldexpedient tools to provide care. The Grand to Grand Ultra is a 7-day, 6-stage, selfsupported foot race held in September and covering 169 miles from the Grand Canyon in Arizona to the Grand Staircase Monument in Utah. The State University of New York Upstate Medical University, through its Wilderness and Expedition Medicine program within the Department of Emergency Medicine, provides primary medical support to the race. Before the event, a planning group is convened to build a practical curriculum and assemble the necessary medical and staff resources to provide coverage to the race, using the opportunity to implement a new curriculum. We hypothesized that our curriculum would both be practical and efficacious in the field, providing a novel educational experience for program participants. In preparation for the race, it was determined that staffing would consist of 5 physicians, including the EMS Medicine fellow, the Wilderness and Expedition Medicine fellow, 2 licensed emergency medicine residents (postgraduate year 2 and 4), 1 paramedic, and a department faculty member (J.J.) who also served as the race medical director, yielding a total of 4 learners who
Letters to the Editor underwent the entirety of the educational experience. One-hour-long didactic sessions were held before the event to review core topics in race and prehospital medicine, including heat illness, dehydration, foot care, and exercise-induced hyponatremia, for a total of 4 hours. Using this information, fellows assisted in the development of the race supply list and medical operations plan, which included coordination with local EMS, law enforcement, and search and rescue teams. The residents assisted the fellows in all duties and in the implementation of the medical action plan as determined during the prerace informational meetings. After the race, postevent debriefing meetings occurred, during which an assessment of the course’s overall efficacy and satisfaction was undertaken. A total of 4 learners underwent the educational experience in 2013. The total duration of the curriculum including the race was 8 days. The participating physicians universally stated that their educational experience was a positive one, and all surveyed stated that they would repeat the event if given the opportunity. Patient encounter numbers were not tallied because traditional visits were replaced by continuous contact time with participants. Physician learners were expected to provide medical checks at every checkpoint and then again in the evening rest hours. A centrally located medical tent became a hub of social gathering, regular foot and skin care, and education. The hands-on medical care was positively received by the participating medical providers as well as by the individuals participating in the race. A few medical emergencies arose on the racecourse, which were met by the physician team and managed successfully without evacuation. Each physician carried a small bag termed an ALS (advanced life support) bag, which contained minimal emergency equipment and supplies for a small subset of racerelated medical threats. Prehospital medicine is an integral part of an emergency medical education at both the resident and fellow level. Our utilization of a remote ultramarathon event to fulfill the requirements of the ACGME core competencies is unique in both its implementation and innovation. We were able to deliver a multifaceted curriculum that allowed not only for the acquisition of technical knowledge through the didactic curriculum and planning meetings but also the translational knowledge derived from the hands-on care administered onsite. Although there were 2 subdivisions of learner (resident and fellow), the curriculum and experience was broad enough to adequately meet the educational needs of each participant. Fellows assumed a greater leadership
577 role during the event as reflected by their autonomous provision of care to race participants at various checkpoints, whereas residents operated under the auspices of the medical director. Each group rated their educational experience positively, allowing us to set this curriculum to be further used in the coming years for future events. Jeremy Joslin, MD Joshua Mularella, DO Susan Schreffler, MD William F Paolo, MD Department of Emergency Medicine SUNY Upstate Syracuse, NY References 1. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medical services. Available at: http://www. acgme.org/acgmeweb/portals/0/pfassets/2013-pr-faq-pif/110_ emergency_medicine_07012013.pdf. Accessed February 5, 2014. 2. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medicine. Available at: http://www. acgme.org/acgmeweb/tabid/131/ProgramandInstitutionalAc creditation/Hospital-BasedSpecialties/EmergencyMedicine. aspx. Accessed February 11, 2014. 3. Katzer R, Cabanas JG, Martin Gill C. SAEM Emergency Medical Services Interest Group. Emergency medical services education in emergency medicine residency programs: a national survey. Acad Emerg Med. 2012;19:174–179. 4. Martin Gill C, Roth RN, Mosesso VN Jr. Resident field response in an emergency medicine prehospital care rotation. Prehosp Emerg Care. 2010;14:370–376. 5. Krabak BJ, Waite B, Schiff MA. Study of injury and illness rates in multiday ultramarathon runners. Med Sci Sports Exerc. 2011;43:2314–2320.
Wilderness Medicine Curricular Content in Emergency Medicine Residency Programs To the Editor: Interest in wilderness medicine has increased in recent years, and physicians from many specialties have shown growing interest in the field. Multiple educational opportunities are now available at the student, resident, and practicing physician levels. It is not surprising that many emergency physicians are drawn to the practice of wilderness medicine. The fields share similar qualities in that they involve a broad range of medical knowledge, the urgent and emergent application of stabilization and
Letters to the Editor
injury and protection of athlete health supported by the International Olympic Committee. Paul Salmon’s contribution was funded by an ARC Future Fellowship (FT140100681). Natassia Goode, PhD Paul M. Salmon, PhD Centre for Human Factors and Sociotechnical Systems, Faculty of Arts and Business, School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia Michael G. Lenné, PhD Monash Injury Research Institute Monash University Melbourne, Victoria, Australia Caroline F. Finch, PhD Australian Centre for Research Into Injury in Sport and Its Prevention, Federation University Australia, Mount Helen, Victoria, Australia References 1. Salmon PM, Goode N, Lenné MG, Finch CF, Cassell E. Injury causation in the great outdoors: a systems analysis of led outdoor activity injury incidents. Accid Anal Prev. 2014;63:111–120. 2. Goode N, Salmon PM, Taylor N, Lenne M, Finch C. Bridging the research-practice gap: validity of a software tool designed to support systemic accident analysis by risk managers. Paper presented at: HCI International 2015; August 2–7, 2015; Los Angeles, California. 3. Salmon PM, Cornelissen M, Trotter MJ. Systems-based accident analysis methods: a comparison of Accimap, HFACS, and STAMP. Safety Sci. 2012;50:1158–1170. 4. Goode N, Finch CF, Cassell E, Lenné MG, Salmon PM. What would you like? Identifying the required characteristics of an industry-wide incident reporting and learning system for the led outdoor activity sector. AJOE. 2014;17:2–15. 5. Goode N, Salmon PM, Taylor N, Lenne M, Finch CF. A test of a systems theory-based incident coding taxonomy for risk managers. In: Ahram T, Karwowski W, Marek T, eds. Proceedings of the 5th International Conference on Applied Human Factors and Ergonomics AHFE 2014. July 19–23, 2014; Kraków, Poland. Krakow, Poland: The Printing House; 2014.
Race Medicine: A Novel Educational Experience for GME Learners To the Editor: Emergency medical services (EMS) and prehospital medicine are required areas of competency for
graduation from Emergency Medicine residency programs.1 Most programs use a traditional ride-along model in which residents spend time in EMS vehicles, participating in prehospital care, and assisting providers in the field.2,3 Although the standard model has primarily involved participation in urban 911 calls along with exposure to EMS agency administration, unconventional methods for achieving and meeting the core requirements have arisen to meet the challenge of innovating education to meet changing resident expectations.4 In addition, the growth of Accreditation Council for Graduate Medical Education (ACGME)–approved EMS fellowships has added to the learner pool, necessitating the exploration of new avenues and methodologies to achieve prehospital requirements. Race medicine is a relatively modern subset of medicine, encompassing event and mass-gathering medicine, wilderness medicine, expeditions medicine, sports medicine, EMS medicine, primary care, and emergency medicine. In many cases, races are held in remote and geographically interesting places over the course of several days. These events may involve large numbers of participants who de facto have been separated from the reach of emergency services infrastructure. Race physicians frequently encounter injury and illness related to both routine medical care and specific medical threats as a result of environment and activity.5 Furthermore, much of the medical equipment and processes used in an emergency department are unavailable, and physicians must use a heightened clinical acumen and fieldexpedient tools to provide care. The Grand to Grand Ultra is a 7-day, 6-stage, selfsupported foot race held in September and covering 169 miles from the Grand Canyon in Arizona to the Grand Staircase Monument in Utah. The State University of New York Upstate Medical University, through its Wilderness and Expedition Medicine program within the Department of Emergency Medicine, provides primary medical support to the race. Before the event, a planning group is convened to build a practical curriculum and assemble the necessary medical and staff resources to provide coverage to the race, using the opportunity to implement a new curriculum. We hypothesized that our curriculum would both be practical and efficacious in the field, providing a novel educational experience for program participants. In preparation for the race, it was determined that staffing would consist of 5 physicians, including the EMS Medicine fellow, the Wilderness and Expedition Medicine fellow, 2 licensed emergency medicine residents (postgraduate year 2 and 4), 1 paramedic, and a department faculty member (J.J.) who also served as the race medical director, yielding a total of 4 learners who
Letters to the Editor underwent the entirety of the educational experience. One-hour-long didactic sessions were held before the event to review core topics in race and prehospital medicine, including heat illness, dehydration, foot care, and exercise-induced hyponatremia, for a total of 4 hours. Using this information, fellows assisted in the development of the race supply list and medical operations plan, which included coordination with local EMS, law enforcement, and search and rescue teams. The residents assisted the fellows in all duties and in the implementation of the medical action plan as determined during the prerace informational meetings. After the race, postevent debriefing meetings occurred, during which an assessment of the course’s overall efficacy and satisfaction was undertaken. A total of 4 learners underwent the educational experience in 2013. The total duration of the curriculum including the race was 8 days. The participating physicians universally stated that their educational experience was a positive one, and all surveyed stated that they would repeat the event if given the opportunity. Patient encounter numbers were not tallied because traditional visits were replaced by continuous contact time with participants. Physician learners were expected to provide medical checks at every checkpoint and then again in the evening rest hours. A centrally located medical tent became a hub of social gathering, regular foot and skin care, and education. The hands-on medical care was positively received by the participating medical providers as well as by the individuals participating in the race. A few medical emergencies arose on the racecourse, which were met by the physician team and managed successfully without evacuation. Each physician carried a small bag termed an ALS (advanced life support) bag, which contained minimal emergency equipment and supplies for a small subset of racerelated medical threats. Prehospital medicine is an integral part of an emergency medical education at both the resident and fellow level. Our utilization of a remote ultramarathon event to fulfill the requirements of the ACGME core competencies is unique in both its implementation and innovation. We were able to deliver a multifaceted curriculum that allowed not only for the acquisition of technical knowledge through the didactic curriculum and planning meetings but also the translational knowledge derived from the hands-on care administered onsite. Although there were 2 subdivisions of learner (resident and fellow), the curriculum and experience was broad enough to adequately meet the educational needs of each participant. Fellows assumed a greater leadership
577 role during the event as reflected by their autonomous provision of care to race participants at various checkpoints, whereas residents operated under the auspices of the medical director. Each group rated their educational experience positively, allowing us to set this curriculum to be further used in the coming years for future events. Jeremy Joslin, MD Joshua Mularella, DO Susan Schreffler, MD William F Paolo, MD Department of Emergency Medicine SUNY Upstate Syracuse, NY References 1. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medical services. Available at: http://www. acgme.org/acgmeweb/portals/0/pfassets/2013-pr-faq-pif/110_ emergency_medicine_07012013.pdf. Accessed February 5, 2014. 2. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medicine. Available at: http://www. acgme.org/acgmeweb/tabid/131/ProgramandInstitutionalAc creditation/Hospital-BasedSpecialties/EmergencyMedicine. aspx. Accessed February 11, 2014. 3. Katzer R, Cabanas JG, Martin Gill C. SAEM Emergency Medical Services Interest Group. Emergency medical services education in emergency medicine residency programs: a national survey. Acad Emerg Med. 2012;19:174–179. 4. Martin Gill C, Roth RN, Mosesso VN Jr. Resident field response in an emergency medicine prehospital care rotation. Prehosp Emerg Care. 2010;14:370–376. 5. Krabak BJ, Waite B, Schiff MA. Study of injury and illness rates in multiday ultramarathon runners. Med Sci Sports Exerc. 2011;43:2314–2320.
Wilderness Medicine Curricular Content in Emergency Medicine Residency Programs To the Editor: Interest in wilderness medicine has increased in recent years, and physicians from many specialties have shown growing interest in the field. Multiple educational opportunities are now available at the student, resident, and practicing physician levels. It is not surprising that many emergency physicians are drawn to the practice of wilderness medicine. The fields share similar qualities in that they involve a broad range of medical knowledge, the urgent and emergent application of stabilization and