Addressing microaggressions with simulation: a novel educational intervention.

There is an urgent need for education around equity, diversity, inclusivity, indigeneity, and accessibility (EDIIA). One important facet of this is gender-related microaggressions, which are a common occurrence in the emergency department. Most emergency medicine residents receive few opportunities to discuss, understand, and approach these occurrences in the clinical setting. To address this, we created a novel immersive session exploring gender-based microaggressions through a simulation experience followed by reflective teaching to foster allyship and practice tools for responding to microaggressions. An anonymous survey was subsequently distributed to elicit feedback, which was positive. After this successful pilot, next steps include creating sessions to address other microaggressions. Limitations include implicit biases of facilitators and ensuring that facilitators can engage in brave spaces and open conversations. Others trying to integrate gendered microaggression training into their EDIIA curricula could model our innovation.

RéSUMé: Il existe un besoin urgent d'éducation sur l'équité, la diversité, l'inclusivité, l'indigénéité et l'accessibilité (EDIIA). Les micro-agressions liées au genre, qui sont monnaie courante dans les services d'urgence, en sont une facette importante. La plupart des résidents en médecine d'urgence ont peu d'occasions de discuter, de comprendre et d'aborder ces événements en milieu clinique. Pour y remédier, nous avons créé une nouvelle session immersive explorant les micro-agressions basées sur le genre par le biais d'une expérience de simulation suivie d'un enseignement réflexif pour favoriser l'alliance et la pratique d'outils pour répondre aux micro-agressions. Un sondage anonyme a ensuite été distribué pour obtenir des commentaires, qui ont été positifs. Après ce projet pilote réussi, les prochaines étapes comprennent la création de séances pour aborder d'autres micro-agressions. Les limites comprennent les préjugés implicites des animateurs et la garantie que les animateurs peuvent s'engager dans des espaces courageux et des conversations ouvertes. D'autres personnes qui tentent d'intégrer une formation sur les micro-agressions sexistes dans leur programme EDIIA pourraient s'inspirer de notre innovation.

The Future of Emergency Medicine (EM) Sim Cases: A Modified Massive Online Needs Assessment.

Objective Emergency Medicine (EM) Sim Cases was initially developed in 2015 as a free open-access simulation resource. To ensure the future of EM Sim Cases remains relevant and up to date, we performed a needs assessment to better define our audience and facilitate long-term goals. Methods We delivered a survey using a modified massive-online-needs-assessment methodology through an iterative process with simulation experts from the EM Simulation Educators Research Collaborative. We distributed the survey via email and Twitter and analyzed the data using descriptive statistics and thematic analysis. Results We obtained 106 responses. EM Sim Cases is commonly used by physicians primarily as an educational resource for postgraduate level trainees. Perceived needs included resuscitation, pediatrics, trauma, and toxicology content. Prompted needs included non-simulation-case educational resources, increased case database, and improved website organization. Conclusions Data collected from our needs assessment has defined our audience allowing us to design our long-term goals and strategies.

Simulation in the Continuing Professional Development of Academic Emergency Physicians: A Canadian National Survey.

INTRODUCTION: Simulation is becoming a popular educational modality for physician continuing professional development (CPD). This study sought to characterize how simulation-based CPD (SBCPD) is being used in Canada and what academic emergency physicians (AEPs) desire in an SBCPD program. METHODS: Two national surveys were conducted from March to June 2018. First, the SBCPD Needs Assessment Survey was administered online to all full-time AEPs across 9 Canadian academic emergency medicine (EM) sites. Second, the SBCPD Status Survey was administered by telephone to the department representatives (DRs)-simulation directors or equivalent-at 20 Canadian academic EM sites. RESULTS: Response rates for the SBCPD Needs Assessment and the SBCPD Status Survey were 40% (252/635) and 100% (20/20) respectively. Sixty percent of Canadian academic EM sites reported using SBCPD, although only 30% reported dedicated funding support. Academic emergency physician responses demonstrated a median annual SBCPD of 3 hours. Reported incentivization for SBCPD participation varied with AEPs reporting less incentivization than DRs. Academic emergency physicians identified time commitments outside of shift, lack of opportunities, and lack of departmental funding as their top barriers to participation, whereas DRs thought AEPs fear of peer judgment and inexperience with simulation were substantial barriers. Content areas of interest for SBCPD were as follows: rare procedures, pediatric resuscitation, and neonatal resuscitation. Lastly, interprofessional involvement in SBCPD was valued by both DRs and AEPs. CONCLUSIONS: Simulation-based CPD programs are becoming common in Canadian academic EM sites. Our findings will guide program coordinators in addressing barriers to participation, selecting content, and determining the frequency of SBCPD events.

Harnessing the power of simulation for assessment: Consensus recommendations for the use of simulation-based assessment in emergency medicine.

OBJECTIVES: To address the increasing demand for the use of simulation for assessment, our objective was to review the literature pertaining to simulation-based assessment and develop a set of consensus-based expert-informed recommendations on the use of simulation-based assessment as presented at the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. METHODS: A panel of Emergency Medicine (EM) physicians from across Canada, with leadership roles in simulation and/or assessment, was formed to develop the recommendations. An initial scoping literature review was conducted to extract principles of simulation-based assessment. These principles were refined via thematic analysis, and then used to derive a set of recommendations for the use of simulation-based assessment, organized by the Consensus Framework for Good Assessment. This was reviewed and revised via a national stakeholder survey, and then the recommendations were presented and revised at the consensus conference to generate a final set of recommendations on the use of simulation-based assessment in EM. CONCLUSION: We developed a set of recommendations for simulation-based assessment, using consensus-based expert-informed methods, across the domains of validity, reproducibility, feasibility, educational and catalytic effects, acceptability, and programmatic assessment. While the precise role of simulation-based assessment will be a subject of continued debate, we propose that these recommendations be used to assist educators and program leaders as they incorporate simulation-based assessment into their programs of assessment.

Simulation-based research in emergency medicine in Canada: Priorities and perspectives.

OBJECTIVE: Simulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM). METHODS: Simulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators. RESULTS: Twenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology. CONCLUSION: This study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.

Managing cognitive load in simulations: exploring the role of simulation technologists.

BACKGROUND: Facilitating simulation is a complex task with high cognitive load. Often simulation technologists are recruited to help run scenarios and lower some of the extraneous load. We used cognitive load theory to explore the impact of technologists on instructors, identifying sources of instructor cognitive load with and without technologists present. METHODS: Data were collected from 56 simulation sessions for postgraduate emergency medicine residents. Instructors delivered 14 of the sessions without a technologist. After each session, the instructor and simulation technologist (if present) provided quantitative and qualitative data on the cognitive load of the simulation. RESULTS: Instructors rated their cognitive load similarly, regardless of whether simulation technologists were present. However, the composition of their cognitive load differed. Instructors experienced reduced cognitive load related to the simulator and technical resources when technologists were present. Qualitative feedback from instructors suggested real consequences to these differences in cognitive load in (1) perceived complexities in running the scenario, and (2) observations of learners. CONCLUSION: We provide evidence that simulation technologists can remove some of the extraneous load related to the simulator and technical resources for the instructor, allowing the instructor to focus more on observing the learner(s) and tailoring the scenario to their actions.

CONTEXTE: Faciliter la simulation est une tâche complexe qui comporte une charge cognitive élevée. Des technologues en simulation sont souvent recrutés pour aider à exécuter des scénarios et à alléger la charge extrinsèque. Nous avons utilisé la théorie de la charge cognitive pour explorer l'impact des technologues sur les instructeurs, en identifiant les sources de la charge cognitive de l'instructeur avec et sans la présence du technologue. MÉTHODES: Les données ont été recueillies à partir de 56 ateliers de simulation auprès des résidents en médecine d'urgence. Les instructeurs ont animé 14 de ces ateliers sans technologue. Après chaque session, l'instructeur et le technologue en simulation (s'il était présent) ont fourni des données quantitatives et qualitatives sur la charge cognitive associée à la simulation. RÉSULTATS: Les instructeurs ont évalué leur charge cognitive de façon similaire indépendamment de la présence du technologue en simulation. Cependant, la composition de leur charge cognitive était différente. Les instructeurs ont subi une moindre charge cognitive liée au simulateur et aux ressources techniques en présence des technologues. La rétroaction qualitative des instructeurs a suggéré des conséquences réelles liées aux différences de charges cognitives concernant (1) les complexités perçues en exécutant le scénario, et (2) les observations des apprenants. CONCLUSION: Nous fournissons des données probantes suggérant que les technologues en simulation puissent éliminer une partie de la charge extrinsèque liée au simulateur et aux ressources techniques, ce qui permet à l'instructeur de se concentrer davantage sur l'observation de l'apprenant et d'adapter le scénario à leurs actions.

Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients.

STUDY OBJECTIVE: To present a review of out-of-hospital identification of ST-segment elevation myocardial infarction patients transported by emergency medical services with 12-lead ECG and advance notification versus standard or no cardiac monitoring. METHODS: EMBASE, PubMed, and the Cochrane Library were searched, using controlled vocabulary and keywords. Randomized controlled trials and observational studies were included. Outcomes included short-term mortality (≤30 days), door-to-balloon/needle time and/or first medical contact-to-balloon/needle time. Pooled estimates were determined, where appropriate. Results were stratified by percutaneous coronary intervention or fibrinolysis. RESULTS: The search yielded 1,857 citations, of which 68 full-texts were reviewed and 16 studies met the final criteria: 15 included data on percutaneous coronary intervention and 3 on fibrinolysis (2 included both). Where percutaneous coronary intervention was performed, out-of-hospital 12-lead ECG and advance notification was associated with a 39% reduction in short-term mortality (8 studies; n=6,339; risk ratio 0.61; 95% confidence interval 0.42 to 0.89; P=.01; I(2)=30%) compared with standard or no cardiac monitoring. Where fibrinolysis was performed, out-of-hospital 12-lead ECG and advance notification was associated with a 29% reduction in short-term mortality (1 study; n=17,026; risk ratio 0.71; 95% confidence interval 0.54 to 0.93; P=.01). First medical contact-to-balloon, door-to-balloon, and door-to-needle times were consistently reduced, though large heterogeneity generally precluded pooling. CONCLUSION: The present study adds to previous reviews by identifying and appraising the strength and quality of a larger body of evidence. Out-of-hospital identification with 12-lead ECG and aadvance notification was found to be associated with reductions in short-term mortality and first medical contact-to-balloon, door-to-balloon, and door-to-needle time.