Development and implementation of an in-hospital pharmacist emergency response simulation training curriculum.

BACKGROUND: Medical simulation is an effective educational tool used to increase confidence, improve knowledge, and refine skills when responding to high-acuity situations. Despite established roles of the pharmacist on the hospital code team, most institutions lack formalized pharmacist training for code team responses. OBJECTIVE: This pre-post analysis aimed to evaluate the impact of a didactic and simulation-based code response training for pharmacists on self-perceived improvement and preparedness when responding to in-hospital medical emergencies. METHODS: An emergency response curriculum (ERC) was developed for pharmacists and pharmacy residents at our institution. The curriculum, led by 4 lead clinical pharmacy specialists, included a 60-minute didactic code competency lecture followed by 2 medical emergency simulations and a debrief after each scenario. After completion of the simulation portion of the ERC, participants were given a survey to complete that assessed their confidence using a 5-point Likert scale (1 = very unconfident to 5 = very confident) in completing the course objectives before and after the ERC. RESULTS: Seventy-two pharmacists completed the ERC and 60 completed the postcourse survey. Of those who completed the postcourse survey, 70% were pharmacy residents. Using a 5-point Likert scale (1 = very unconfident to 5 = very confident), median participant confidence rose from 3 (interquartile range [IQR] 2-4) before the session to 4 (IQR 3-5) after the session (P < 0.001). Of the participants, 95% believed the ERC training should be required annually or multiple times a year and 100% of respondents felt the ERC training was beneficial. CONCLUSION: Development of a pharmacist ERC including didactic and simulation-based learning improved the confidence and preparedness of pharmacists when participating as members of the hospital code team. Future studies should continue to evaluate pharmacist training and curriculum development in code team responses.

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach.

Background: Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence. Methods: In this pre-/postintervention study, ED physicians were enrolled to participate in a 2-h, in-person simulation training session composed of a didactic session followed by rotation through stations using handmade pork-based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural-based competence were assessed pre- and posttraining via electronic survey quizzes. One-way repeated-measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre- and postintervention were compared. Results: In total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56% were trainees, 39% were faculty, 56% were female, and 53% self-identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p < 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self-reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30). Conclusions: A low-cost, low-fidelity simulation curriculum can improve ED provider procedural-based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED-based UGNB use.

Simulation-Based Breast Biopsy Training Using a Low-Cost Gelatin-Based Breast Model in Rwanda.

BACKGROUND: An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy and assessed first-time user experience. METHODS: An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy for approximately $4.40 USD. Components include medical-grade gelatin, Jell-O™, water, olives, and surgical gloves. The model was used to train two cohorts comprising 30 students total during their junior surgical clerkship. The learners' experience and perceptions on the first Kirkpatrick level were evaluated using pre- and post-training surveys. RESULTS: Response rate was 93.3% (n = 28). Only three students had previously completed an ultrasound-guided breast biopsy, and none had prior exposure to simulation-based breast biopsy training. Learners that were confident in performing biopsies under minimal supervision rose from 4 to 75% following the session. All students indicated the session increased their knowledge, and 71% agreed that the model was an anatomically accurate and appropriate substitute to a real human breast. CONCLUSIONS: The use of a low-cost gelatin-based breast model was able to increase student confidence and knowledge in performing ultrasound-guided breast biopsies. This innovative simulation model provides a cost-effective and more accessible means of simulation-based training especially for low- and middle-income settings.

The test developer's dilemma: Evaluating the balance of feasibility and empiric performance of test development techniques for repeated written assessments.

PURPOSE: Written assessments face challenges when administered repeatedly, including resource-intensive item development and the potential for performance improvement secondary to item recall as opposed to understanding. This study examines the efficacy of three-item development techniques in addressing these challenges. METHODS: Learners at five training programs completed two 60-item repeated assessments. Items from the first test were randomized to one of three treatments for the second assessment: (1) Verbatim repetition, (2) Isomorphic changes, or (3) Total revisions. Primary outcomes were the stability of item psychometrics across test versions and evidence of item recall influencing performance as measured by the rate of items answered correctly and then incorrectly (correct-to-incorrect rate), which suggests guessing. RESULTS: Forty-six learners completed both tests. Item psychometrics were comparable across test versions. Correct-to-incorrect rates differed significantly between groups with the highest guessing rate (lowest recall effect) in the Total Revision group (0.15) and the lowest guessing rate (highest recall effect) in the Verbatim group (0.05), p = 0.01. CONCLUSIONS: Isomorphic and total revisions demonstrated superior performance in mitigating the effect of recall on repeated assessments. Given the high costs of total item revisions, there is promise in exploring isomorphic items as an efficient and effective approach to repeated written assessments.[Box: see text].

Ovarian Hyperstimulation Syndrome: A Simulation Case for Emergency Medicine Residents.

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a complication of assisted reproductive technology (ART) for infertility. Given the potential for significant morbidity, it is important for emergency medicine (EM) residents to be able to recognize and initiate treatment for this disorder. Methods: A high-fidelity human patient simulator was used, with availability of bedside ultrasound. PGY 1-4 EM residents participated in this case of a 28-year-old female patient undergoing treatment for infertility who presented to the emergency department with shortness of breath and near syncope. Workup revealed a diagnosis of OHSS. After the simulation, we surveyed residents on their knowledge of OHSS prior to participation in the simulation. We also asked about their confidence in caring for a patient with OHSS pre- and postsimulation based on a 5-point Likert scale. Results: A total of 24 EM residents completed this simulation case. Prior to participating in the simulation experience, 62% of residents reported that they had heard of OHSS, and 17% of residents had previously managed a patient with OHSS. After participating in the simulation, residents' comfort with managing a patient with OHSS increased from 1.7 to 3.7 points (1 = not at all comfortable, 5 = extremely comfortable; p < .001). Discussion: OHSS is a rare but important complication of ART that many EM residents have not treated in the clinical environment. As the presenting symptoms may mimic other diagnoses, obtaining a detailed history and utilizing bedside ultrasonography are essential to diagnosing and correctly treating these patients.

The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study.

BACKGROUND: Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being. OBJECTIVE: We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift. METHODS: Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights' sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post-overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls. RESULTS: In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights' sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI -0.90 to -0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI -0.81 to -0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores. CONCLUSIONS: Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions' effect on other populations of shift workers' post-night shift alertness, users' long-term physical and mental health, and patient outcomes.

Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool.

INTRODUCTION: Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice. METHODS: This was a mixed methods study conducted in 2 phases, following Kane's validity framework. The intended use of the NTS tool is to provide formative assessment of US EM physicians (EPs) from a video of simulated clinical encounters. In phase I, a focus group assessed the appropriateness of each aspect of the tool in the context of US EM practice by reviewing and identifying the NTS of an EP in a simulated clinical scenario. In phase II, EPs (N = 208) attending a national EM conference evaluated an EP's behaviors in 1 of 2 video simulations. Reliability in the form of internal consistency was calculated using Cronbach α. All participants suggested exemplar behaviors for the 12 elements in the context of their own clinical practice and generated new assessment elements. RESULTS: Internal consistency was acceptable (α > 0.7) for all categories, except teamwork and cooperation. Participants proposed 4 novel behavioral elements and suggested US exemplar behaviors for all 12 original elements. CONCLUSIONS: This tool can be used to assess US EP's NTS for the purpose of formative assessment. Refinement of exemplar behaviors and inclusion of novel US-specific elements may optimize usability.

Sedation - Effects of disorders of abuse on therapeutic efficacy (SEDATE): A retrospective cohort study.

BACKGROUND: The impact of alcohol or opioid use disorders on medication dosing for procedural sedation in the emergency department (ED) is unclear, as most of the literature is from gastrointestinal endoscopy. Exploring how these patient factors affect sedative and analgesic medications may inform more nuanced sedation strategies in the emergency department. METHODS: This was a retrospective chart-review cohort study across five EDs from 2015 to 2020. Included were adult patients who underwent procedural sedation in the ED, categorized into three a priori groups: alcohol use disorder (AUD), opioid use disorder (OUD), and individuals with neither (non-SUD). Wilcoxon test was used to compare the time-averaged dose of agents between groups. Logistic regression was used to model multi-agent sedations. The propofol time-averaged dose was the primary outcome. Secondary outcomes included other agents, sedation duration, and switching to other agents. RESULTS: 2725 sedations were included in the analysis. 59 patients had a history of AUD, and 40 had a history of OUD. Time-averaged doses of medications did not differ significantly between AUD and non-SUD patients. Likewise, patients with OUD did not receive different doses of medications compared to non-SUD. The propofol doses for non-SUD, AUD, and OUD were 0.033 IQR 0.04; 0.042 IQR 0.05; and 0.058 IQR 0.04 mg/kg*min, respectively. Sedation duration was not different across groups. Having AUD or OUD is not associated with increased odds of requiring multiple sedative agents. CONCLUSION: Although sedation in patients with AUD or OUD may be associated with significant case bias, these patient factors did not significantly alter outcomes compared to the general population. This study suggests there is no evidence to proactively adjust medication strategy in ED patients with AUD or OUD.

Virtual student experiences: A case study of objectives, outcomes, and anticipated consequences.

Due to the COVID-19 pandemic, most in-person visiting clerkship opportunities have been canceled. Many institutions have developed virtual experiences to fill this void; however, the format and objectives of these experiences are variable. This article describes an education intervention for visiting students where both learner-oriented and program-oriented outcomes of a nonclerkship virtual student experience are explored. This intervention consisted of five 1-hour case-based teaching sessions in addition to attendance at weekly residency conference over a 1-week period. The primary outcomes were student ratings of how the experience impacted their 1) perception of the program's educational environment and culture, 2) medical knowledge, and 3) program ranking before and after the experience. Of 24 participants, 15 students (63%) completed the final evaluation, all with positive summative rankings in every domain measured. Of the 15 respondents, 12 (80%) reported an increase in where they would rank the program after the experience compared to before, and nine of 15 (60%) stated that they would rank the program #1 if making a list at the time they completed the final evaluation. Future study should examine long-term outcomes of these interventions including decisions regarding where students apply, who programs interview, and ranking decisions of students and programs.

Design and Implementation of a Low-Cost Priapism Reduction Task Trainer.

Audience: This low-cost priapism reduction task trainer is designed to instruct emergency medicine (EM) resident physicians. Introduction: Priapism is a true urologic emergency that EM physicians must be able to diagnose and treat in order to prevent significant tissue damage and loss of erectile function. Given the nature of the condition, priapism treatment is often both physically invasive and psychologically upsetting. Simulation allows learners to practice invasive or rare procedures in a safe and educational environment. At present, there are few inexpensive and easily created task trainers for priapism reduction. Our goal was to create an inexpensive, reusable task trainer that allows learners to practice the skills needed for priapism reduction. Educational Objectives: By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection. Educational Methods: Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including administering local anesthesia, medication injection, and realistic cavernosal aspiration with simulated blood return. As part of a standard EM residency didactics curriculum, this task trainer has been used to teach post graduate year (PGY) 1-4 resident learners. After an introductory didactic session, participants were given the opportunity for hands-on skills-based practice using the simulated task trainer. Research Methods: Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. Results: We were able to successfully create a low cost, easy to build partial task trainer for priapism reduction that allowed learners to perform local anesthesia, medication injections, and corporal aspiration. Twenty-five residents (ten PGY-1, five PGY-2, five PGY-3, five PGY-4) participated in a single didactic session and completed a post-session survey. The majority (68%, N=17) of participants had never previously treated a patient with priapism. On average, participants rated their comfort managing a patient with priapism before the session to be 1.76 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort increased to 3.76 on the same scale. Participants rated the usefulness of the priapism model for teaching priapism reduction techniques to be 4.64 on a 5- point scale (where 1=not at all useful and 5=extremely useful). Discussion: Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including local anesthesia, medication injection, and cavernosal aspiration. Learners reported that the educational session greatly increased their confidence in caring for patients presenting with priapism. Additionally, they found the priapism model to be extremely helpful for teaching reduction techniques. Our model was successful in teaching a procedure that providers may encounter in clinical practice yet most resident learners had not yet had the opportunity to perform in training. Topics: Penile anesthesia, priapism reduction, urologic emergencies.

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer.

Audience: This facial and dental regional anesthesia task trainer is designed for teaching emergency medicine (EM) residents and medical students; however, it can be used by other specialties including plastic surgery, otolaryngology, oral surgery, and dentistry. Introduction: While the opioid epidemic remains a public health crisis, emergency departments (EDs) continue to treat patients who require painful facial procedures or who present with severe dental pain. There is increasing interest and renewed use of regional anesthesia for procedural anesthesia and as an effective non-opioid analgesic. Although many nerve blocks are now being taught using ultrasound guidance, regional anesthesia of the face and mouth is still performed using landmark-based techniques. To date, there are no commercially available task trainers for teaching regional anesthesia of the face and mouth. Therefore, a low-cost, feedback-enhanced, partial task trainer was created for teaching regional anesthesia of the supraorbital, infra-orbital, mental, and inferior alveolar nerves. Educational Objectives: By the end of this educational session, learners should be able to:Describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves.Successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer. Educational Methods: Using inexpensive and commonly found materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. When the needle is inserted in the correct nerve location by the learner, the task trainer provides positive feedback in the form of an audible alert. This innovative task trainer has been used to teach post graduate year (PGY) 1-4 resident learners as part of a standard emergency medicine residency didactics curriculum. After a brief introductory didactic session, participants are given the opportunity for hands-on skills practice using the task trainer under faculty supervision. Research Methods: An existing airway task trainer was successfully modified in order to create a feedback-enhanced, partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. Results: Twenty-one residents (10 PGY-1, 9 PGY-3, 2 PGY-4) participated in a didactic session and all completed a brief post-session survey. Many participants (N=10, 48%) had never previously performed any of these nerve blocks. On average, participants rated their comfort performing these specific nerve blocks before the session to be 1.96 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort level increased to 3.67 on the same scale. Participants rated the usefulness of the feedback-enhanced task trainer to be a 4.71 on a 5-point scale (where 1=not at all useful and 5=extremely useful). Discussion: Using inexpensive and commonly available materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching regional anesthesia of the face and mouth. Learners reported that the educational session greatly increased their confidence in performing supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks. Additionally, they found the feedback-enhanced partial task trainer to be extremely helpful for teaching appropriate landmark identification. Our model was successfully used to teach facial and dental nerve block techniques which are able to provide both procedural anesthesia and non-opioid analgesia. Future studies could investigate whether this educational session and model leads to increased competence and/or increased performance of facial nerve blocks in the clinical setting. Topics: Nerve blocks, regional anesthesia, dental emergencies, facial trauma.

Use of a Refresher Course Increases Confidence in Point-of-Care Ultrasound Skills in Emergency Medicine Faculty.

Introduction All practicing emergency medicine (EM) physicians need to maintain a skillset in emergency ultrasound (US) after their initial training. EM physicians in academic practice may be supervising trainees performing ultrasound applications that they aren't comfortable with. This study investigates the effectiveness of a US refresher course. The hypothesis was that a series of short courses would increase confidence in performing and supervising US applications. Methods Nine basic emergency ultrasound applications were taught over the course of one year by ultrasound fellowship-trained EM faculty in a simulation center at a single academic institution. Each session included 30-minutes of didactics/image review and 30-minutes of hands-on practice on normal volunteers and was followed by an anonymous questionnaire evaluating comfort level performing and supervising the ultrasound application before and after the course using a Likert scale from 1 "not at all confident" to 5 "very confident". Results Thirty-six of 60 EM physicians participated in at least 1 of the 9 sessions (median 3, interquartile range 2-4). Faculty who attended had a median of 10 (interquartile range 7-15) years in practice and 61% work at both academic and community sites. For all sessions combined, confidence in performing US increased from a mean score on the Likert scale of 3.3 to 4.4 (difference 1.1, confidence interval (CI) (0.94, 1.29), p < 0.001) and confidence in supervising trainees increased from a mean of 3.4 to 4.5 (difference 1.1, CI (0.88, 1.23), p < 0.001). The largest increases were seen in musculoskeletal (MSK), nerve, and pelvic applications and the least increase was seen with the session focused on intravenous access, but confidence was increased in all sessions. Physicians in practice ≥10 years increased in confidence in performing and supervising the applications by 1.4 (CI (1.11, 1.60), p < 0.001) and 1.3, (CI (1.01, 1.49), p < 0.001), respectively. Physicians in practice <10 years increased 0.8 (CI (0.57, 1.03), p < 0.001) and 0.8 (CI (0.55, 1.05), p < 0.001), respectively. Conclusion An emergency ultrasound refresher course for EM physicians at a single institution improved self-reported confidence in both performing and supervising trainees in all applications reviewed. Those in practice ≥10 years showed the largest increases.

The Impact of Video Laryngoscopy on the Clinical Learning Environment of Emergency Medicine Residents: A Report of 14,313 Intubations.

BACKGROUND: The introduction of video laryngoscopy (VL) may impact emergency medicine (EM) residents' intubation practices. METHODS: We analyzed 14,313 intubations from 11 EM training sites, July 1, 2002, to December 31, 2012, assessing the likelihood of first-attempt success and likelihood of having a second attempt, by rank and device. We determined whether direct laryngoscopy (DL) first-attempt success decreased as VL became more prevalent using a logistic regression model with proportion of encounters initiated with VL at that center in the prior 90 and 365 days as predictors of DL first-attempt success. RESULTS: First-attempt success by PGY-1s was 71% (95% confidence interval [CI] = 63% to 78%); PGY-2s, 82% (95% CI = 78% to 86%); and PGY-3+, 89% (95% CI = 85% to 92%). Residents' first-attempt success rate was higher with the C-MAC video laryngoscope (C-MAC) versus DL, 92% versus 84% (risk difference [RD] = 8%, 95% CI = 4% to 11%), but there was no statistical difference between the GlideScope video laryngoscope (GVL) and DL, 80% versus 84% (RD = -4%, 95% CI = -10% to 1%). PGY-1s were more likely to have a second intubation attempt after first-attempt failure with VL versus DL: 32% versus 18% (RD = 14%, 95% CI = 5% to 23%). DL first-attempt success rates did not decrease as VL became more prevalent. CONCLUSIONS: First-attempt success increases with training. Interns are more likely to have a second attempt when using VL. The C-MAC may be associated with increased first-attempt success for EM residents compared with DL or GVL. The increasing prevalence of VL is not accompanied by a decrease in DL success.

Hemorrhage Control Training Promotes Resilience-Associated Traits in Medical Students.

OBJECTIVE: Given rising rates of physician burnout, the potential for clinical skills training programs to develop and reinforce resilience-associated traits in medical students warrants investigation. The primary objective of this study was to examine the impact of a hemorrhage control training program on resilience-associated traits (role-clarity, self-efficacy, and empowerment) in medical students. A secondary objective was to examine the differential impact of additional hands-on skills training. DESIGN: This was a prospective study of medical students participating in an established hemorrhage control training program, utilizing pre-, mid-, and post-training questionnaires. The program included both an in-person lecture and hands-on skills training. Primary endpoints were self-reported increases in role clarity (when the hemorrhage control skills would and would not be applicable), self-efficacy (confidence in ability to use the skill), and empowerment (to act in a situation where the skill was needed). SETTING: Harvard Medical School, Boston, Massachusetts. PARTICIPANTS: One hundred and twenty-six Harvard Medical School students participated. RESULTS: There was a significant increase at each stage of training in self-reported role clarity about when to apply hemorrhage control skills (p < 0.01) and when not to apply them (p < 0.01); confidence in application of the skill (p < 0.01); as well as empowerment to apply the skill when appropriate (p < 0.01). CONCLUSIONS: Hemorrhage control training, a first response-related clinical skills program, is a promising domain for development and reinforcement of resilience-associated traits in medical students, particularly when the program includes hands-on skills training. Providing experiential learning opportunities that are designed not only for skills-specific outcomes, but also to reinforce such resilience-associated traits as role-clarity, self-efficacy, and empowerment provides an essential integrated perspective.

Feasibility of Bystander Administration of Public-Access Naloxone for Opioid Overdose.

OBJECTIVE: Pre-stationing naloxone, a competitive antagonist that can reverse the effects of opioid overdose, in public spaces may expedite antidote delivery. Our study aimed to determine the feasibility of bystander-assisted overdose treatment using pre-stationed naloxone. METHODS: Convenience sample of bystanders in Cambridge, Massachusetts in April 2017. Subjects assisted a simulated patient described as unconscious. Subjects interacted with simulated EMS dispatch to locate a nearby box, unlock it, and administer naloxone. RESULTS: Fifty participants completed the simulation. Median time from simulated ambulance dispatch to naloxone administration was 189 seconds, and from arrival at patient side to administration 61 seconds. All but one participant (98.0%) correctly administered naloxone. Subjects' comfort with administration and willingness to provide medical care increased from before to after the trial. Comfort in administering naloxone varied significantly with level of previous training prior to, but not following, study participation. CONCLUSIONS: Bystanders are willing and able to access pre-stationed naloxone and administer it to a simulated patient in a public space. Public access naloxone stations may be a useful tool to reduce time to naloxone administration, particularly in areas where opioid overdoses are clustered.