- Email: [email protected]
The Medical Student “Dime” Lecture
CORD Abstracts BEST PRACTICES BEST OF THE BEST PRESENTATION
44
A 5 Year Study of Emergency Medicine Intern Objective Structured Clinical Examination (OSCE) Performance Does Not Correlate With Emergency Medicine Faculty Evaluation of Resident Performance
Shih R, Silverman M, Mayer C/Morristown Medical Center, Morristown, NJ
Background: Objective Structured Clinical Examination (OSCE) has been used extensively in medical schools for assessment and teaching purposes. Its use in EM assessment or resident performance is limited. Little information exists regarding its usefulness in this setting. Objective: To compare EM OSCE and faculty evaluation of clinical performance. Methods: All EM interns over a 5-year period underwent OSCE examinations using 7 standardized patient encounters. These encounters included scenarios involving abdominal pain, dyspnea, obesity, panic attack, medical error, autopsy, and pharmaceutical representative interaction. In addition, all EM interns underwent faculty evaluations by EM faculty during the same month of OSCE performance to assess their clinical performance in the areas of history taking (HX), physical examination (PE), interpersonal skills (IPS) and overall performance (OP). All responses were collected using a 100-mm visual analog scale (0¼worst intern ever and 100¼best intern ever). Two faculty members reviewed all data. The clinical performance scores for the OSCE and faculty assessment scores were correlated using Spearman correlation statistics to obtain correlation coefficients. P<.05 was considered statistically significant. Results: A total of 36 residents underwent OSCE and EM faculty evaluations. When comparing OSCE scores with faculty evaluation scores, there was no correlation for history taking (r¼–0.10; P¼.55), physical examination (r¼0.03; P¼.86), overall performance (r¼–0.14; P¼.41) and interpersonal skills (r¼–0.21; P¼.41) that was statistically significant. Conclusions: OSCE assessment of clinical performance in EM interns does not appear to correlate with EM faculty assessment of clinical performance. The role of OSCE examinations in the evaluation of EM interns is unclear and needs further study.
BEST PRACTICES EDUCATIONAL SOUNDBITES PRESENTATION
45
Asynchronous Education: Podcasts and Panel Discussions: A Platform for Discussion and Education
Doctor S, Moores T, Stroud S, Fix M/University of Utah, Salt Lake City, UT
Introduction: The medium of medical education is changing. As we shift toward learners of the Web 2.0 generation, we have found it important to provide feedback on information that residents may obtain on their own. Many residents cite that the majority of their education comes from online podcasts, which may or may not be related to residency curricular content or the local practice standard. For this reason, we implemented a novel curriculum of asynchronous podcast panel discussions into our conference didactics. Educational Objectives: To provide a medium for discussion and attending input on education that residents are obtaining through various podcasts that are available online. Curricular Design: We implemented a series of 1 hour of panel discussions per topic module (eg, pulmonary) that correlate with an assigned podcast. A podcast was chosen from an easily available and affordable online source such as EM:RAP, EMCrit, or ERCast. Residents and faculty were provided the podcast 1 to 2 weeks prior to the panel date. Panel experts and field specialists from EM, as well as other relevant specialties, were chosen to match topics from the podcasts. A SurveyMonkey quiz on topics covered was used to ensure resident participation. Residents assigned to the educational block helped organize/moderate the panel discussion. Topics thus far have included panel discussions on sepsis and fluid responsiveness, massive transfusion protocols, imaging abdominal pain in pregnancy, and delayed sequence intubation with 2 recognized local airway experts and videoconferencing Dr. Scott Weingart of EMCRIT. Impact/Effectiveness: Resident and faculty response to our version of asynchronous education has been overwhelmingly positive and allowed us to address many of the criticisms of asynchronous education. Using readily available podcasts and educational
Volume 62, no. 5 : November 2013
content, we are able to provide consistent up-to-date educational material with realtime discussions with local and national experts.
BEST PRACTICES EDUCATIONAL SOUNDBITES PRESENTATION
46
ENCoRe: Emergency Nursing Collaboration With Residents
Heitz C, Kuehl D/Carilion Roanoke Memorial Hospital/Virginia Tech Carilion School of Medicine, Roanoke, VA
Introduction: Emergency medicine exemplifies the close interaction between physicians and nurses as part of a treatment team. Functional teams depend on each member’s understanding others’ skill sets and roles. ENCoRe was created to build a foundation of understanding, respect, and collaboration between ED residents and nurses. Educational Objectives: 1. Demonstrate an understanding of nursing role, skill sets in the ED. 2. Demonstrate an understanding of nurses’ approach to assessment, multitasking, teamwork, resource use, time management. 3. Demonstrate ability to perform a select set of nursing skills. 4. Conduct professional, collaborative interactions with the ENCoRe nurse and ED staff. Curricular Design: Residents are paired with an ENCoRe nurse at the start of their residency. The nursing administration and Carilion Clinic-Virginia Tech Carilion EM residency faculty select each nurse. Residents work 1 shift every 6 months with their nurse and function as the nurse’s assistant and perform nursing tasks for that entire shift. The nurses provide oversight and direction to the resident with respect to their interactions with the nursing and ancillary staff of the ED. Impact/Effectiveness: Participants were surveyed about their experiences. Residents’ understanding of nursing roles/skills improved (4.1/5 [95% CI 3.6 to 4.6] preshift; 4.6 [95% CI 4.4 to 4.9] postshift), as did their comfort level working with ED staff (4.5 [95% CI 4.0 to 4.9] preshift; 4.6 [95% CI 4.4 to 4.9] postshift) and comfort with procedural performance (4.1 [95% CI 3.6 to 4.6] preshift; 4.6 [95% CI 4.3 to 4.8] postshift). Comfort level with approaching nursing staff was high (4.6/5 pre- and postshift) and did not change. Nurses’ comfort level interacting with residents improved (4.0 [95% CI 3.2 to 4.8] preshift; 4.6 [95% CI 4.2 to 5] postshift), as did their understanding of residents’ skills (2.6 [95% CI 1.9 to 3.3] preshift; 3.6 [95% CI 3.2 to 4.0] postshift). Conclusions: Nurses and residents participating in ENCoRe report increased levels of comfort with interactions and understanding of one another’s roles and skills.
CDEM CURRICULAR INNOVATIONS PRESENTATION
47
The Medical Student “Dime” Lecture Desai S/University of Kentucky, Lexington, KY
Introduction: Evaluation of medical students is an important but difficult task. In the past, fourth-year students have been asked to give a lecture to the course director (and each other) on broad topics and typically do so in a slide format. Usually, the level of these presentations is inadequate for resident education. Objective: To create a format for students to effectively teach residents and staff about a topic in a format that is well received by all levels. The goal is also for the student to learn how to effectively read literature on a specific topic and then present it in a format that can be interesting. Presentations provide another tool for faculty and residents to evaluate students. Curricular Design: The format, labeled the “dime” lecture, is an approximately 10-minute mainly verbal lecture (slides only for pictures). The course director created the specific topics (Figure). Students present information from recent articles and up-to-date sources. Students assume the audience understood the basics and focus more on updated information, diagnostic modalities, and treatment. This model gives students more face-to-face time with the faculty and residents and allows faculty to better evaluate the capabilities of students. We assessed the “dimes” by resident and faculty evaluations and commentary. Key difficulties to overcome include fairly strict time limits and use of slides only for visual aids. It was important that the course director pick topics because students usually create broad topics, occasionally non-EM related. Impact: After using these lectures over the first 4 blocks of our fourth-year curriculum, our faculty and residents feel better able to evaluate students. These
Annals of Emergency Medicine S181
CORD Abstracts “dimes” will only be done during the first 4 blocks. Significant discussion afterType>Annals of Emergency MedicineCopyright © 2013 Elsevier, Inc. All rights reserved.Elsevier, Inc0196-0644625November 2013201311S167S182S167S18210.1016/j.annemergmed.2013.06.026http://dx.doi.org/10.1016/ j.annemergmed.2013.06.026doi:10.1016/j.annemergmed.2013.06.0266.410.1016/ j.annemergmed.2013.06.026noindexElsevierTrue the presentations occurred. Qualitative evaluations have been extremely positive from students, faculty, and residents, with all groups recommending continuation next year. Figure. Examples of topics.
Methods: This computer-assisted retrospective study compared new patients per hour and patient load before and after the closure of large nearby hospitals. New patient workups per hour and the 4 PM and 3 AM patient census per resident were examined for 24 days before and after the hurricane. New patients per hour were calculated for all EM residents and were analyzed as new patients per hour by resident level for all patients, patients arriving by ambulance, and ESI level 1 and 2 patients. Results: Resident productivity was essentially unchanged, as measured by new patients per hour, new ESI 1 or 2 patients per hour. New ambulance patients per hour increased slightly for EM-1, EM-2, and EM-3 residents (P¼.09, .12, and .04, respectively). EM-1, 2, and 3 residents were caring for more patients at 4 PM and 3 AM. Conclusion: Resident productivity did not increase during a postdisaster surge. Increased crowding resulted in residents caring for more patients in all periods and reflected the decreased overall departmental efficiency caused by crowding and boarding. Increased staffing during postdisaster surge is necessary because productivity remains flat. New patients per hour per EM year Workups per hr
Ambulance pts per hr
ESI level 1 or 2 pts per hr
Year
PRE
POST
PRE
POST
PRE
POST
EM 1 EM 2 EM 3
.85 1.2 1.1
.87 .96 1.0
.29 .44 .42
.36 .48 .55*
.04 .14 .15
.06 .12 .12
LIGHTNING ORALS PRESENTATION
48
Does Resident Productivity Increase When Disaster Strikes?
P < .05
Husk G, Sarin R, Tran C, Heller M, Akhtar S/Beth Israel Medical Center, New York, NY
Background: There are no significant data on resident productivity after surge accompanying a major natural disaster with multiple nearby hospital closures. We examined resident productivity and workload before (PRE) and after (POST) the closure of 4 large urban EDs near our facility after Hurricane Sandy struck the New York area on October 29, 2012. This resulted in a rapid 22% increase in our census, 19% increase in admissions, and 63% increase in ambulance arrivals. Although we increased provider staffing, the queue of patients increased, bed access decreased, and cycle times increased. Objectives: We hypothesized that the closure of multiple nearby hospitals with a resulting influx of ED patients would not change resident productivity.
S182 Annals of Emergency Medicine
Patients per resident at 4:00 pm and 3:00 am 4:00 pm
3:00 am
Year
PRE
POST
PRE
POST
EM 1 EM 2 EM 3
3.0 4.3 3.9
4.9* 5.2* 5.6*
3.8 4.9 6.5
4.8* 5.3 6.7
*P < .05
Volume 62, no. 5 : November 2013
44
A 5 Year Study of Emergency Medicine Intern Objective Structured Clinical Examination (OSCE) Performance Does Not Correlate With Emergency Medicine Faculty Evaluation of Resident Performance
Shih R, Silverman M, Mayer C/Morristown Medical Center, Morristown, NJ
Background: Objective Structured Clinical Examination (OSCE) has been used extensively in medical schools for assessment and teaching purposes. Its use in EM assessment or resident performance is limited. Little information exists regarding its usefulness in this setting. Objective: To compare EM OSCE and faculty evaluation of clinical performance. Methods: All EM interns over a 5-year period underwent OSCE examinations using 7 standardized patient encounters. These encounters included scenarios involving abdominal pain, dyspnea, obesity, panic attack, medical error, autopsy, and pharmaceutical representative interaction. In addition, all EM interns underwent faculty evaluations by EM faculty during the same month of OSCE performance to assess their clinical performance in the areas of history taking (HX), physical examination (PE), interpersonal skills (IPS) and overall performance (OP). All responses were collected using a 100-mm visual analog scale (0¼worst intern ever and 100¼best intern ever). Two faculty members reviewed all data. The clinical performance scores for the OSCE and faculty assessment scores were correlated using Spearman correlation statistics to obtain correlation coefficients. P<.05 was considered statistically significant. Results: A total of 36 residents underwent OSCE and EM faculty evaluations. When comparing OSCE scores with faculty evaluation scores, there was no correlation for history taking (r¼–0.10; P¼.55), physical examination (r¼0.03; P¼.86), overall performance (r¼–0.14; P¼.41) and interpersonal skills (r¼–0.21; P¼.41) that was statistically significant. Conclusions: OSCE assessment of clinical performance in EM interns does not appear to correlate with EM faculty assessment of clinical performance. The role of OSCE examinations in the evaluation of EM interns is unclear and needs further study.
BEST PRACTICES EDUCATIONAL SOUNDBITES PRESENTATION
45
Asynchronous Education: Podcasts and Panel Discussions: A Platform for Discussion and Education
Doctor S, Moores T, Stroud S, Fix M/University of Utah, Salt Lake City, UT
Introduction: The medium of medical education is changing. As we shift toward learners of the Web 2.0 generation, we have found it important to provide feedback on information that residents may obtain on their own. Many residents cite that the majority of their education comes from online podcasts, which may or may not be related to residency curricular content or the local practice standard. For this reason, we implemented a novel curriculum of asynchronous podcast panel discussions into our conference didactics. Educational Objectives: To provide a medium for discussion and attending input on education that residents are obtaining through various podcasts that are available online. Curricular Design: We implemented a series of 1 hour of panel discussions per topic module (eg, pulmonary) that correlate with an assigned podcast. A podcast was chosen from an easily available and affordable online source such as EM:RAP, EMCrit, or ERCast. Residents and faculty were provided the podcast 1 to 2 weeks prior to the panel date. Panel experts and field specialists from EM, as well as other relevant specialties, were chosen to match topics from the podcasts. A SurveyMonkey quiz on topics covered was used to ensure resident participation. Residents assigned to the educational block helped organize/moderate the panel discussion. Topics thus far have included panel discussions on sepsis and fluid responsiveness, massive transfusion protocols, imaging abdominal pain in pregnancy, and delayed sequence intubation with 2 recognized local airway experts and videoconferencing Dr. Scott Weingart of EMCRIT. Impact/Effectiveness: Resident and faculty response to our version of asynchronous education has been overwhelmingly positive and allowed us to address many of the criticisms of asynchronous education. Using readily available podcasts and educational
Volume 62, no. 5 : November 2013
content, we are able to provide consistent up-to-date educational material with realtime discussions with local and national experts.
BEST PRACTICES EDUCATIONAL SOUNDBITES PRESENTATION
46
ENCoRe: Emergency Nursing Collaboration With Residents
Heitz C, Kuehl D/Carilion Roanoke Memorial Hospital/Virginia Tech Carilion School of Medicine, Roanoke, VA
Introduction: Emergency medicine exemplifies the close interaction between physicians and nurses as part of a treatment team. Functional teams depend on each member’s understanding others’ skill sets and roles. ENCoRe was created to build a foundation of understanding, respect, and collaboration between ED residents and nurses. Educational Objectives: 1. Demonstrate an understanding of nursing role, skill sets in the ED. 2. Demonstrate an understanding of nurses’ approach to assessment, multitasking, teamwork, resource use, time management. 3. Demonstrate ability to perform a select set of nursing skills. 4. Conduct professional, collaborative interactions with the ENCoRe nurse and ED staff. Curricular Design: Residents are paired with an ENCoRe nurse at the start of their residency. The nursing administration and Carilion Clinic-Virginia Tech Carilion EM residency faculty select each nurse. Residents work 1 shift every 6 months with their nurse and function as the nurse’s assistant and perform nursing tasks for that entire shift. The nurses provide oversight and direction to the resident with respect to their interactions with the nursing and ancillary staff of the ED. Impact/Effectiveness: Participants were surveyed about their experiences. Residents’ understanding of nursing roles/skills improved (4.1/5 [95% CI 3.6 to 4.6] preshift; 4.6 [95% CI 4.4 to 4.9] postshift), as did their comfort level working with ED staff (4.5 [95% CI 4.0 to 4.9] preshift; 4.6 [95% CI 4.4 to 4.9] postshift) and comfort with procedural performance (4.1 [95% CI 3.6 to 4.6] preshift; 4.6 [95% CI 4.3 to 4.8] postshift). Comfort level with approaching nursing staff was high (4.6/5 pre- and postshift) and did not change. Nurses’ comfort level interacting with residents improved (4.0 [95% CI 3.2 to 4.8] preshift; 4.6 [95% CI 4.2 to 5] postshift), as did their understanding of residents’ skills (2.6 [95% CI 1.9 to 3.3] preshift; 3.6 [95% CI 3.2 to 4.0] postshift). Conclusions: Nurses and residents participating in ENCoRe report increased levels of comfort with interactions and understanding of one another’s roles and skills.
CDEM CURRICULAR INNOVATIONS PRESENTATION
47
The Medical Student “Dime” Lecture Desai S/University of Kentucky, Lexington, KY
Introduction: Evaluation of medical students is an important but difficult task. In the past, fourth-year students have been asked to give a lecture to the course director (and each other) on broad topics and typically do so in a slide format. Usually, the level of these presentations is inadequate for resident education. Objective: To create a format for students to effectively teach residents and staff about a topic in a format that is well received by all levels. The goal is also for the student to learn how to effectively read literature on a specific topic and then present it in a format that can be interesting. Presentations provide another tool for faculty and residents to evaluate students. Curricular Design: The format, labeled the “dime” lecture, is an approximately 10-minute mainly verbal lecture (slides only for pictures). The course director created the specific topics (Figure). Students present information from recent articles and up-to-date sources. Students assume the audience understood the basics and focus more on updated information, diagnostic modalities, and treatment. This model gives students more face-to-face time with the faculty and residents and allows faculty to better evaluate the capabilities of students. We assessed the “dimes” by resident and faculty evaluations and commentary. Key difficulties to overcome include fairly strict time limits and use of slides only for visual aids. It was important that the course director pick topics because students usually create broad topics, occasionally non-EM related. Impact: After using these lectures over the first 4 blocks of our fourth-year curriculum, our faculty and residents feel better able to evaluate students. These
Annals of Emergency Medicine S181
CORD Abstracts “dimes” will only be done during the first 4 blocks. Significant discussion afterType>Annals of Emergency MedicineCopyright © 2013 Elsevier, Inc. All rights reserved.Elsevier, Inc0196-0644625November 2013201311S167S182S167S18210.1016/j.annemergmed.2013.06.026http://dx.doi.org/10.1016/ j.annemergmed.2013.06.026doi:10.1016/j.annemergmed.2013.06.0266.410.1016/ j.annemergmed.2013.06.026noindexElsevierTrue the presentations occurred. Qualitative evaluations have been extremely positive from students, faculty, and residents, with all groups recommending continuation next year. Figure. Examples of topics.
Methods: This computer-assisted retrospective study compared new patients per hour and patient load before and after the closure of large nearby hospitals. New patient workups per hour and the 4 PM and 3 AM patient census per resident were examined for 24 days before and after the hurricane. New patients per hour were calculated for all EM residents and were analyzed as new patients per hour by resident level for all patients, patients arriving by ambulance, and ESI level 1 and 2 patients. Results: Resident productivity was essentially unchanged, as measured by new patients per hour, new ESI 1 or 2 patients per hour. New ambulance patients per hour increased slightly for EM-1, EM-2, and EM-3 residents (P¼.09, .12, and .04, respectively). EM-1, 2, and 3 residents were caring for more patients at 4 PM and 3 AM. Conclusion: Resident productivity did not increase during a postdisaster surge. Increased crowding resulted in residents caring for more patients in all periods and reflected the decreased overall departmental efficiency caused by crowding and boarding. Increased staffing during postdisaster surge is necessary because productivity remains flat. New patients per hour per EM year Workups per hr
Ambulance pts per hr
ESI level 1 or 2 pts per hr
Year
PRE
POST
PRE
POST
PRE
POST
EM 1 EM 2 EM 3
.85 1.2 1.1
.87 .96 1.0
.29 .44 .42
.36 .48 .55*
.04 .14 .15
.06 .12 .12
LIGHTNING ORALS PRESENTATION
48
Does Resident Productivity Increase When Disaster Strikes?
P < .05
Husk G, Sarin R, Tran C, Heller M, Akhtar S/Beth Israel Medical Center, New York, NY
Background: There are no significant data on resident productivity after surge accompanying a major natural disaster with multiple nearby hospital closures. We examined resident productivity and workload before (PRE) and after (POST) the closure of 4 large urban EDs near our facility after Hurricane Sandy struck the New York area on October 29, 2012. This resulted in a rapid 22% increase in our census, 19% increase in admissions, and 63% increase in ambulance arrivals. Although we increased provider staffing, the queue of patients increased, bed access decreased, and cycle times increased. Objectives: We hypothesized that the closure of multiple nearby hospitals with a resulting influx of ED patients would not change resident productivity.
S182 Annals of Emergency Medicine
Patients per resident at 4:00 pm and 3:00 am 4:00 pm
3:00 am
Year
PRE
POST
PRE
POST
EM 1 EM 2 EM 3
3.0 4.3 3.9
4.9* 5.2* 5.6*
3.8 4.9 6.5
4.8* 5.3 6.7
*P < .05
Volume 62, no. 5 : November 2013