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TF4 Learning Electrocardiogram Interpretation Through Deliberate Practice
Research Forum Abstracts
TF4
Learning Electrocardiogram Interpretation Through Deliberate Practice
Tupchong K, Pusic M/NYU School of Medicine, New York, NY
Study Objectives: Electrocardiogram (ECG) interpretation is a vital skill for emergency medicine residents (EMR). However, there is currently no reliable, competency-based assessment standard for ECG skill and no evidence-based data on how many ECGs one needs to interpret in order to achieve competence. Deliberate practice (DP) is a structured way of learning with four components: 1) narrow goals that isolate specific skills, 2) focuses on weaknesses, 3) provides immediate feedback, 4) requires massive repetition. The creation of a computerized ECG learning program based on the tenets of DP may offer a robust model to simultaneously aid learning of ECG interpretation and establish defensible competency thresholds for trainees. EMR will 1) improve their accuracy of ECG interpretation, 2) learn which ECG interpretations they commonly confuse (eg, pericarditis versus STEMI), and 3) learn the trajectory of their skill acquisition of ECG interpretation. Investigators will 4) determine the number of ECGs that EMR must interpret to achieve competency thresholds. Methods: EMR (PGY 1-4) will each log in to an online learning activity management system with unique identifiers. Over 3 months, they will be shown ECGs from a database of more than 300 (reviewed by two cardiologists), one at a time and asked to select from a list of interpretations (eg, anterior STEMI). After the EMR interpretation, immediate feedback will indicate the abnormalities. This process, based on the principles of DP will be repeated until 100 ECGs have been completed, providing the opportunity to be exposed to multiple examples of similar ECGs (eg, anterior STEMI). Following this, they will each be given an individual confusion matrix (Figure 1), along with a learning curve (Figure 2). This will provide EMR with an overview of strengths and weaknesses in ECG interpretation and allow them to tailor further study. EMR feedback will be used to improve upon the existing collection of ECGs. Upon analyzing the learning curves of each PGY class, competency thresholds for accuracy of ECG interpretation will be established. Conclusion: Developing a computerized ECG learning module based the principles of DP may be an effective way of facilitating EMR skill acquisition. Generating confusion matrices may allow for targeted individualized study. By using learner data to generate learning curves, one may be able to diagnose a learner, predict the trajectory of their learning, and gain insight into the number of cases required to achieve competence.
Figure 1. Confusion matrix for one learner. Cells along the diagonal are correct answers. Numbers in the cells are the number of cases where the learner disagreed with the gold standard answer (eg, 4 cases of anterolateral STEMI were confused with pericarditis).
S152 Annals of Emergency Medicine
Figure 2. Learning curve showing the trajectory of skill acquisition of one learner in comparison to peers.
TF5
Practical Aspects in Pediatric Trauma Beylin M/UCSF, San Francisco, CA
Introduction: A needs assessment was conducted and senior UCSF-SFGH emergency medicine (EM) residents reported feeling under prepared in managing severely injured pediatric trauma patients and felt like there was too much practice variation in pediatric cervical spine clearance and application of Pediatric Emergency Care Applied Research Network (PECARN) head rules. This module fills that void and acts as a supplement to the existing trauma curriculum. Objectives: Upon completion of this supplementary module emergency medicine PGY1-4 residents will be able to 1) state the indication and demonstrate comfort with various interventions in pediatric trauma resuscitation; 2) apply PECARN head rules to their everyday practice for minor head injuries and engage parents in shared medical decision making regarding imaging; and 3) discuss the differences between clearing the pediatric cervical spine and adult cervical spine and identify pediatric specific cervical spine injuries. Methods: This is a supplementary three-and-a-half hour pediatric trauma curriculum. It is not meant as a standalone, but rather embedded into the UCSF-SFGH existing residency weekly conference trauma block that spans four weeks and 16 hours. It is composed of 1) a 90-minute pediatric trauma resuscitation small group skills session where learners rotate between three 30-minute stations with two instructors at each station complete with pre-requisite readings and a procedure video; 2) a 60 minute mixed level learner small group self-guided Jeopardy session on pediatric cervical spine injury; and 3) a 60-minute PowerPoint lecture on the PECARN approach to pediatric head injuries. Both 60-minute sessions will give experts (pediatric EM faculty who speak on these subjects nationally) a chance to discuss nuances and the more controversial points on the subject. Residents are evaluated on procedural skills during their small group sessions and receive feedback on their head injury counseling during sessions in addition to evaluation through a brief multiple choice quiz at the end of the module. Results: The module was well received and residents found all three sessions useful in their approach to and management of pediatric trauma patients. Conclusion: This module should continue to be provided in the residency curriculum as it fills a void in knowledge and application of pediatric-specific trauma resuscitation topics. In evaluation of the module learners reported the material covered in the 90-minute procedural skills workshop would be best solidified by a high-fidelity simulation case.
TF6
Adventures in Teaching Millennials: Population Health, Community Engagement, and Design Thinking for First Year Medical Students
Newberry J/Stanford School of Medicine, Stanford, CA
Study Objective: Population health and the social determinants of health are increasingly central targets for improving health in the United States and globally. This
Volume 68, no. 4s : October 2016
TF4
Learning Electrocardiogram Interpretation Through Deliberate Practice
Tupchong K, Pusic M/NYU School of Medicine, New York, NY
Study Objectives: Electrocardiogram (ECG) interpretation is a vital skill for emergency medicine residents (EMR). However, there is currently no reliable, competency-based assessment standard for ECG skill and no evidence-based data on how many ECGs one needs to interpret in order to achieve competence. Deliberate practice (DP) is a structured way of learning with four components: 1) narrow goals that isolate specific skills, 2) focuses on weaknesses, 3) provides immediate feedback, 4) requires massive repetition. The creation of a computerized ECG learning program based on the tenets of DP may offer a robust model to simultaneously aid learning of ECG interpretation and establish defensible competency thresholds for trainees. EMR will 1) improve their accuracy of ECG interpretation, 2) learn which ECG interpretations they commonly confuse (eg, pericarditis versus STEMI), and 3) learn the trajectory of their skill acquisition of ECG interpretation. Investigators will 4) determine the number of ECGs that EMR must interpret to achieve competency thresholds. Methods: EMR (PGY 1-4) will each log in to an online learning activity management system with unique identifiers. Over 3 months, they will be shown ECGs from a database of more than 300 (reviewed by two cardiologists), one at a time and asked to select from a list of interpretations (eg, anterior STEMI). After the EMR interpretation, immediate feedback will indicate the abnormalities. This process, based on the principles of DP will be repeated until 100 ECGs have been completed, providing the opportunity to be exposed to multiple examples of similar ECGs (eg, anterior STEMI). Following this, they will each be given an individual confusion matrix (Figure 1), along with a learning curve (Figure 2). This will provide EMR with an overview of strengths and weaknesses in ECG interpretation and allow them to tailor further study. EMR feedback will be used to improve upon the existing collection of ECGs. Upon analyzing the learning curves of each PGY class, competency thresholds for accuracy of ECG interpretation will be established. Conclusion: Developing a computerized ECG learning module based the principles of DP may be an effective way of facilitating EMR skill acquisition. Generating confusion matrices may allow for targeted individualized study. By using learner data to generate learning curves, one may be able to diagnose a learner, predict the trajectory of their learning, and gain insight into the number of cases required to achieve competence.
Figure 1. Confusion matrix for one learner. Cells along the diagonal are correct answers. Numbers in the cells are the number of cases where the learner disagreed with the gold standard answer (eg, 4 cases of anterolateral STEMI were confused with pericarditis).
S152 Annals of Emergency Medicine
Figure 2. Learning curve showing the trajectory of skill acquisition of one learner in comparison to peers.
TF5
Practical Aspects in Pediatric Trauma Beylin M/UCSF, San Francisco, CA
Introduction: A needs assessment was conducted and senior UCSF-SFGH emergency medicine (EM) residents reported feeling under prepared in managing severely injured pediatric trauma patients and felt like there was too much practice variation in pediatric cervical spine clearance and application of Pediatric Emergency Care Applied Research Network (PECARN) head rules. This module fills that void and acts as a supplement to the existing trauma curriculum. Objectives: Upon completion of this supplementary module emergency medicine PGY1-4 residents will be able to 1) state the indication and demonstrate comfort with various interventions in pediatric trauma resuscitation; 2) apply PECARN head rules to their everyday practice for minor head injuries and engage parents in shared medical decision making regarding imaging; and 3) discuss the differences between clearing the pediatric cervical spine and adult cervical spine and identify pediatric specific cervical spine injuries. Methods: This is a supplementary three-and-a-half hour pediatric trauma curriculum. It is not meant as a standalone, but rather embedded into the UCSF-SFGH existing residency weekly conference trauma block that spans four weeks and 16 hours. It is composed of 1) a 90-minute pediatric trauma resuscitation small group skills session where learners rotate between three 30-minute stations with two instructors at each station complete with pre-requisite readings and a procedure video; 2) a 60 minute mixed level learner small group self-guided Jeopardy session on pediatric cervical spine injury; and 3) a 60-minute PowerPoint lecture on the PECARN approach to pediatric head injuries. Both 60-minute sessions will give experts (pediatric EM faculty who speak on these subjects nationally) a chance to discuss nuances and the more controversial points on the subject. Residents are evaluated on procedural skills during their small group sessions and receive feedback on their head injury counseling during sessions in addition to evaluation through a brief multiple choice quiz at the end of the module. Results: The module was well received and residents found all three sessions useful in their approach to and management of pediatric trauma patients. Conclusion: This module should continue to be provided in the residency curriculum as it fills a void in knowledge and application of pediatric-specific trauma resuscitation topics. In evaluation of the module learners reported the material covered in the 90-minute procedural skills workshop would be best solidified by a high-fidelity simulation case.
TF6
Adventures in Teaching Millennials: Population Health, Community Engagement, and Design Thinking for First Year Medical Students
Newberry J/Stanford School of Medicine, Stanford, CA
Study Objective: Population health and the social determinants of health are increasingly central targets for improving health in the United States and globally. This
Volume 68, no. 4s : October 2016