Self-reported evaluation of competencies and attitudes by physicians-in-training before and after a single day legislative advocacy experience.

BACKGROUND: Advocacy is increasingly being recognized as a core element of medical professionalism and efforts are underway to incorporate advocacy training into graduate and undergraduate medical school curricula. While limited data exist to quantify physician attitudes toward advocacy, even less has been done to assess the knowledge, skills, and attitudes of future physicians. The purpose of this study was to assess students' experiences and attitudes toward legislative advocacy, cutting out using a convience sample. METHODS: A paper survey based on previously validated surveys was administered to a convenience sample of premedical and medical student participants attending a National Advocacy Day in Washington, DC, in March 2011, both before and after their advocacy experiences. Responses were anonymous and either categorical ( or ordinal, using a 5-point Likert scale. Data were analyzed statistically to evaluate demographics and compare changes in pre- and post-experience attitude and skills. RESULTS: Data from 108 pre-advocacy and 50 post-advocacy surveys were analyzed yielding a response rate of 46.3%. Following a single advocacy experience, subjects felt they were more likely to contact their legislators about healthcare issues (p = 0.03), to meet in person with their legislators (p < 0.01), and to advocate for populations' health needs (p = 0.04). Participants endorsed an increased perception of the role of a physician advocate extending beyond individual patients (p = 0.03). Participants disagreed with the statement that their formal curricula adequately covered legislative healthcare advocacy. Additionally, respondents indicated that they plan to engage in legislative advocacy activities in the future (p < 0.01). CONCLUSIONS: A one-time practical advocacy experience has a positive influence on students' knowledge, skills and attitudes towards legislative advocacy. Practical experience is an important method of furthering medical education in advocacy and further research is necessary to assess its impact in a broader population.

Peer coaching increases emergency medicine faculty ability to perform and teach awake fiberoptic intubation.

OBJECTIVES: This study sought to evaluate the impact of peer coaching as a continuing medical education (CME) modality to improve faculty performance and teaching of a low-frequency, high-complexity procedure, awake fiberoptic intubation (AFOI). METHODS: Academic emergency medicine faculty at a single tertiary care, Level I trauma center participated in a prospective pre-/postinterventional assessment of a peer coaching educational intervention. Participants completed a preintervention online survey to identify comfort and previous experience with performing and teaching AFOI. The participants reviewed presession materials and then completed a 25-min didactic session with a peer coach. Participants were then broken into dyads where they initially each practiced the procedure and then attempted to teach the procedure to their colleague. An institutional standardized checklist for AFOI was utilized to assess participants procedural competency. Postintervention online surveys were compared to the preintervention surveys. RESULTS: A total of 15 faculty members were recruited for the study and completed pre- and postintervention surveys. All participants showed ability to perform AFOI as proven by successful completion of the procedural checklist. There was a statistically significant increase for self-perceived efficacy in performing (p < 0.001, 95% confidence interval [CI] = 1.34 to 3.06) and teaching AFOI (p < 0.001, 95% CI = 1.56 to 3.05). All participants felt more likely to attempt AFOI after a single peer coaching session and most (14/15, 93.3%) were more likely to teach AFOI. Participants identified peer coaching as more effective at instilling confidence to perform and teach the skill than other CME activities that they have experienced. CONCLUSION: This study demonstrates that peer coaching increases practicing faculty's ability to perform and teach a low-frequency, high-complexity procedure, AFOI. Peer coaching may offer an opportunity to improve the utility of learning compared to more traditional didactic-based CME initiatives.

Neurocognitive function of emergency department patients with mild traumatic brain injury.

STUDY OBJECTIVE: We characterize the neurocognitive function of patients presenting to the emergency department (ED) with mild traumatic brain injury. METHODS: This prospective study took place at an urban, academic ED and Level I trauma center. Case patients consisted of a convenience sample of ED patients aged 18 to 59 years, presenting to the ED with mild traumatic brain injury and having a head computed tomography scan without traumatic abnormalities. Controls consisted of patients aged 18 to 59 years, presenting to the ED with an isolated, nondominant hand extremity injury. We excluded patients with multiple injuries and recent alcohol consumption. Subjects completed a computerized neurocognitive test battery (Immediate Post-concussion Assessment and Cognitive Testing). The primary measures were verbal memory, visual memory, and visual motor and reaction speed. We compared raw and age-normalized neurocognitive performance between case patients and controls by using nonparametric statistics. RESULTS: We included a total of 23 head-injured case patients and 31 non-head-injured controls. Case patients and controls exhibited similar raw (median 80.1 versus 85.0 points; difference in medians -4.9; P=.26) and age-normalized (31.9 versus 57.4 percentile; difference in medians -25.5; P=.12) verbal memory. Case patients and controls exhibited similar raw (64.6 versus 63.5; difference 1.1; P=.79) and age-normalized (20.8 versus 25.8 percentile; difference -5.0; P=.44) visual memory. Compared with controls, mild traumatic brain injury case patients demonstrated slower raw (31.6 versus 37.0 points; difference -5.4; P=.002) and age-normalized (17.1 versus 57.6 percentile; difference -40.5; P=.001) visual motor speed. Mild traumatic brain injury case patients exhibited slower raw (median 0.66 versus 0.60 seconds; difference 0.06; P=.01) and age-normalized (29.3 versus 42.8 percentile; difference -13.5; P=.009) reaction times. CONCLUSION: In conclusion, compared with the non-head-injured patients, ED mild traumatic brain injury patients demonstrated subtle but discernible neurocognitive deficits.

Social Determinants of Health: A Missing Link in Emergency Medicine Training.

The health of a population depends upon several factors, including disease, public health initiatives, and the social determinants of health (SDH). These factors often converge in the emergency department (ED) where the impact of social conditions such as homelessness, low-literacy, and poverty lead to recidivism and may contribute to provider burnout. Inclusion of SDH topics in EM residency curricula can provide needed background information and effective strategies for coping with these patients in the clinical setting. Exercises that simulate poverty, the development of and familiarity with meaningful community partnerships, and inclusion of SDH topics in standard ED conferences (e.g., mortality and morbidity conference) can promote understanding and outline a detailed plan for treating patients facing these challenges. By incorporating educational interventions aimed at identifying and intervening on issues of SDH in the ED we may be able to better serve those patients who need us the most.