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TF5 Teaching Effective Opioid Prescribing Through a Simulation Curriculum
Research Forum Abstracts
TF3
Medic 5 Calling: Teaching On-Line Medical Direction via Simulation
Nable JV/MedStar Georgetown University Hospital, Washington, DC
Introduction: Emergency physicians must be proficient at providing on-line medical command (OLMC) for out-of-hospital providers. Some emergency medicine (EM) residency programs, however, are located in jurisdictions in which local emergency medical services (EMS) protocols require relatively little OLMC, limiting training opportunities. An OLMC curriculum was developed utilizing simulation scenarios. The primary learners are residents at an EM residency. Study Objectives: The learners’ goals are to have an understanding of their local jurisdictional EMS protocols and to become competent at providing OLMC. Methods: This curriculum involves a self-instructional module to be completed by EM interns during their EMS rotation. In this module, the learners are introduced to the concepts of out-of-hospital protocol development and familiarized with the role of emergency physicians in providing real-time EMS medical control. The module teaches learners a standardized method of receiving out-of-hospital radio reports and providing OLMC. The interns also review their local jurisdictional EMS protocols. A protocol test at the conclusion of their EMS week assesses their knowledge of these protocols. During simulation sessions, EM residents are exposed to OLMC scenarios. In the course of a regular simulation setting (for example, managing an emergency department patient with rapid atrial fibrillation), a simulated nurse hands the resident a radio, noting that a out-of-hospital provider is requesting medical command. Each OLMC scenario has critical criteria that must be met in order for the resident to pass. At the conclusion of the scenario, a faculty preceptor discusses the case with the learner, providing immediate feedback and reinforcing key concepts. Conclusion: Providing OLMC is an important role of practicing emergency physicians. Many EMS protocols have reduced the need to contact physicians for medical orders, limiting opportunities for residents to learn this skill while in training. This novel curriculum introduces the concepts of OLMC through a self-instructional module. Various simulated OLMC scenarios are then utilized to provide exposure and feedback to learners.
TF4
Understanding and Navigating the Emergency Medicine Job Market: A Community Practice Perspective
Uller JK/UCSF-Fresno Medical Education Program, Fresno, CA
Introduction: While residency programs do a good job in clinical training of emergency medicine, there is often little to no formal curriculum teaching residents the business side of our specialty to help them find a job that is a good fit for their professional development and personal needs. This lack of formal training may partially account for the high rate of job turnover of recent graduates, with some residency directors estimating 60-70% of residents change jobs within 5 years. Frequent job turnover can delay professional development and advancement and comes with considerable economic cost as well. It may also contribute to early career burnout. Study Objectives: To provide the senior resident a better understanding of the business side of emergency medicine with emphasis on how to find a job that is the right fit for their professional and personal needs. To introduce financial planning topics frequently encountered during the first few years out of residency. Methods: A formalized job search curriculum done over 4 breakout interactive sessions. They are a mixture of lecture and small-group discussion, each about 55 minutes in length. The target audience is senior level residents who are about to begin their job search. The first session covers an introduction to EM group business structures and a general framework to the job search process. The second session involves a CV and cover letter creation workshop, as well as tips on how to prepare for job interviews. The third session focuses on how to compare jobs, including red flags to look out for, and sections on negotiating and contract issues. The final session covers financial planning topics commonly encountered by emergency physicians in their first few years out of residency. Participants will do a pre-course and post-course survey that reflects their comfort level with the material. Ultimately, success will be determined by their ability to find a job that is a good fit for them. Brief electronic email surveys will be sent out to graduates at 2 years and 5 years intervals to follow up on their overall job happiness as well as
Volume 66, no. 4s : October 2015
to measure job turnover rate. Participants will also give feedback regarding the curriculum, so the material can be updated and modified to their experiences in the job market. Conclusion: High job turnover remains a problem in emergency medicine. Formulation of a more structured job search curriculum may help residents choose jobs that better match their personal and professional needs and help decrease the chance of career burnout. Surveys at 2 and 5 years will measure curricular impact.
TF5
Teaching Effective Opioid Prescribing Through a Simulation Curriculum
Boyle KL/University of Massachusetts Medical School, Worcester, MA
Introduction: The epidemic of opioid-associated deaths poses a daily challenge for emergency medicine physicians as they strive to treat pain. The goal of this work is to develop an educational curriculum for residents regarding safe and evidence-based opioid prescribing. To assess the effectiveness of the curriculum, we will determine the number of prescriptions written by residents for specific diagnoses before and after implementation of the curriculum. These diagnoses were identified as conditions in which opioid prescribing was not recommended in the 2012 American College of Emergency Physicians (ACEP) Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. This curriculum was developed as part of a project supported by the 2014 Medical Toxicology Foundation Drug Abuse Prevention Award. Study Objectives: The goals of this curriculum are to: (1) Describe existing guidelines regarding prescription of opioid pain mediations upon patient discharge from the emergency department (ED); (2) Use a simulation curriculum to offer examples of how to navigate difficult patient conversations and teach residents how to provide effective counseling for patients receiving opioid prescriptions; and (3) Use small group discussion to develop lists of best practices, behaviors to avoid, and predictors of opioid misuse in the ED. The overall objective is to decrease the number of inappropriate opioid prescriptions written by EM residents for patients upon discharge from the ED as defined by the ACEP clinical policy. Methods: The curriculum begins with a short lecture to introduce the scope of the opioid abuse epidemic, as well as the prescribing guidelines that exist for EM providers, specifically the ACEP clinical policy. The majority of the curriculum focuses on a simulation encounter using a standardized patient with video recording, debriefing, and small group discussion. The encounter is conducted with a resident volunteer and standardized patient, and is projected for the entire group to watch. After the encounter, small group discussions are held using five discussion points focused on defining best practices for opioid prescribing by EM providers, as well as strategies for dealing with difficult encounters. At the end of the small group discussion, there is a final simulation encounter performed by the same resident, this time using strategies the group developed during their discussion. To measure the effectiveness of the curriculum, the number of opioid prescriptions written by the group of learners on patient discharge from the ED will be collected for a 3-month period prior to the delivery of the curriculum, and after completion of the curriculum. Additionally, the learners will be asked to complete surveys assessing the extent of their training regarding opioid prescribing and their comfort with prescribing opioids prior to data collection, directly after participation in the curriculum, and after completion of data collection. Conclusion: Safe and effective prescribing of opioid pain medications is an important skill for EM providers. Aside from published guidelines, there is still a paucity of formal educational training available regarding prescribing of opioid medications. This curriculum addresses the urgent need for formal training in residency education regarding opioid prescribing on patient discharge from the ED.
TF6
Implementation of the Flipped Classroom Model Using VirtualACEP to Teach a Cardiology Curriculum to Emergency Medicine Residents
Diller D/Oregon Health & Science University, Portland, OR
Introduction: The “flipped classroom” is an educational model that allows educators to deliver didactic content and new material to students outside the classroom, while using classroom time to address students’ questions and reinforce
Annals of Emergency Medicine S157
TF3
Medic 5 Calling: Teaching On-Line Medical Direction via Simulation
Nable JV/MedStar Georgetown University Hospital, Washington, DC
Introduction: Emergency physicians must be proficient at providing on-line medical command (OLMC) for out-of-hospital providers. Some emergency medicine (EM) residency programs, however, are located in jurisdictions in which local emergency medical services (EMS) protocols require relatively little OLMC, limiting training opportunities. An OLMC curriculum was developed utilizing simulation scenarios. The primary learners are residents at an EM residency. Study Objectives: The learners’ goals are to have an understanding of their local jurisdictional EMS protocols and to become competent at providing OLMC. Methods: This curriculum involves a self-instructional module to be completed by EM interns during their EMS rotation. In this module, the learners are introduced to the concepts of out-of-hospital protocol development and familiarized with the role of emergency physicians in providing real-time EMS medical control. The module teaches learners a standardized method of receiving out-of-hospital radio reports and providing OLMC. The interns also review their local jurisdictional EMS protocols. A protocol test at the conclusion of their EMS week assesses their knowledge of these protocols. During simulation sessions, EM residents are exposed to OLMC scenarios. In the course of a regular simulation setting (for example, managing an emergency department patient with rapid atrial fibrillation), a simulated nurse hands the resident a radio, noting that a out-of-hospital provider is requesting medical command. Each OLMC scenario has critical criteria that must be met in order for the resident to pass. At the conclusion of the scenario, a faculty preceptor discusses the case with the learner, providing immediate feedback and reinforcing key concepts. Conclusion: Providing OLMC is an important role of practicing emergency physicians. Many EMS protocols have reduced the need to contact physicians for medical orders, limiting opportunities for residents to learn this skill while in training. This novel curriculum introduces the concepts of OLMC through a self-instructional module. Various simulated OLMC scenarios are then utilized to provide exposure and feedback to learners.
TF4
Understanding and Navigating the Emergency Medicine Job Market: A Community Practice Perspective
Uller JK/UCSF-Fresno Medical Education Program, Fresno, CA
Introduction: While residency programs do a good job in clinical training of emergency medicine, there is often little to no formal curriculum teaching residents the business side of our specialty to help them find a job that is a good fit for their professional development and personal needs. This lack of formal training may partially account for the high rate of job turnover of recent graduates, with some residency directors estimating 60-70% of residents change jobs within 5 years. Frequent job turnover can delay professional development and advancement and comes with considerable economic cost as well. It may also contribute to early career burnout. Study Objectives: To provide the senior resident a better understanding of the business side of emergency medicine with emphasis on how to find a job that is the right fit for their professional and personal needs. To introduce financial planning topics frequently encountered during the first few years out of residency. Methods: A formalized job search curriculum done over 4 breakout interactive sessions. They are a mixture of lecture and small-group discussion, each about 55 minutes in length. The target audience is senior level residents who are about to begin their job search. The first session covers an introduction to EM group business structures and a general framework to the job search process. The second session involves a CV and cover letter creation workshop, as well as tips on how to prepare for job interviews. The third session focuses on how to compare jobs, including red flags to look out for, and sections on negotiating and contract issues. The final session covers financial planning topics commonly encountered by emergency physicians in their first few years out of residency. Participants will do a pre-course and post-course survey that reflects their comfort level with the material. Ultimately, success will be determined by their ability to find a job that is a good fit for them. Brief electronic email surveys will be sent out to graduates at 2 years and 5 years intervals to follow up on their overall job happiness as well as
Volume 66, no. 4s : October 2015
to measure job turnover rate. Participants will also give feedback regarding the curriculum, so the material can be updated and modified to their experiences in the job market. Conclusion: High job turnover remains a problem in emergency medicine. Formulation of a more structured job search curriculum may help residents choose jobs that better match their personal and professional needs and help decrease the chance of career burnout. Surveys at 2 and 5 years will measure curricular impact.
TF5
Teaching Effective Opioid Prescribing Through a Simulation Curriculum
Boyle KL/University of Massachusetts Medical School, Worcester, MA
Introduction: The epidemic of opioid-associated deaths poses a daily challenge for emergency medicine physicians as they strive to treat pain. The goal of this work is to develop an educational curriculum for residents regarding safe and evidence-based opioid prescribing. To assess the effectiveness of the curriculum, we will determine the number of prescriptions written by residents for specific diagnoses before and after implementation of the curriculum. These diagnoses were identified as conditions in which opioid prescribing was not recommended in the 2012 American College of Emergency Physicians (ACEP) Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. This curriculum was developed as part of a project supported by the 2014 Medical Toxicology Foundation Drug Abuse Prevention Award. Study Objectives: The goals of this curriculum are to: (1) Describe existing guidelines regarding prescription of opioid pain mediations upon patient discharge from the emergency department (ED); (2) Use a simulation curriculum to offer examples of how to navigate difficult patient conversations and teach residents how to provide effective counseling for patients receiving opioid prescriptions; and (3) Use small group discussion to develop lists of best practices, behaviors to avoid, and predictors of opioid misuse in the ED. The overall objective is to decrease the number of inappropriate opioid prescriptions written by EM residents for patients upon discharge from the ED as defined by the ACEP clinical policy. Methods: The curriculum begins with a short lecture to introduce the scope of the opioid abuse epidemic, as well as the prescribing guidelines that exist for EM providers, specifically the ACEP clinical policy. The majority of the curriculum focuses on a simulation encounter using a standardized patient with video recording, debriefing, and small group discussion. The encounter is conducted with a resident volunteer and standardized patient, and is projected for the entire group to watch. After the encounter, small group discussions are held using five discussion points focused on defining best practices for opioid prescribing by EM providers, as well as strategies for dealing with difficult encounters. At the end of the small group discussion, there is a final simulation encounter performed by the same resident, this time using strategies the group developed during their discussion. To measure the effectiveness of the curriculum, the number of opioid prescriptions written by the group of learners on patient discharge from the ED will be collected for a 3-month period prior to the delivery of the curriculum, and after completion of the curriculum. Additionally, the learners will be asked to complete surveys assessing the extent of their training regarding opioid prescribing and their comfort with prescribing opioids prior to data collection, directly after participation in the curriculum, and after completion of data collection. Conclusion: Safe and effective prescribing of opioid pain medications is an important skill for EM providers. Aside from published guidelines, there is still a paucity of formal educational training available regarding prescribing of opioid medications. This curriculum addresses the urgent need for formal training in residency education regarding opioid prescribing on patient discharge from the ED.
TF6
Implementation of the Flipped Classroom Model Using VirtualACEP to Teach a Cardiology Curriculum to Emergency Medicine Residents
Diller D/Oregon Health & Science University, Portland, OR
Introduction: The “flipped classroom” is an educational model that allows educators to deliver didactic content and new material to students outside the classroom, while using classroom time to address students’ questions and reinforce
Annals of Emergency Medicine S157