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3.
JAMA Netw Open ; 7(9): e2431600, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-39250155

RESUMO

Importance: Adaptive expertise helps physicians apply their skills to novel clinical cases and reduce preventable errors. Error management training (EMT) has been shown to improve adaptive expertise with procedural skills; however, its application to cognitive skills in medical education is unclear. Objective: To evaluate whether EMT improves adaptive expertise when learning the cognitive skill of head computed tomography (CT) interpretation. Design, Setting, and Participants: This 3-arm randomized clinical trial was conducted from July 8, 2022, to March 30, 2023, in 7 geographically diverse emergency medicine residency programs. Participants were postgraduate year 1 through 4 emergency medicine residents masked to the hypothesis. Interventions: Participants were randomized 1:1:1 to a difficult EMT, easy EMT, or error avoidance training (EAT) control learning strategy for completing an online head CT curriculum. Both EMT cohorts received no didactic instruction before scrolling through head CT cases, whereas the EAT group did. The difficult EMT cohort answered difficult questions about the teaching cases, leading to errors, whereas the easy EMT cohort answered easy questions, leading to fewer errors. All 3 cohorts used the same cases. Main Outcomes and Measures: The primary outcome was a difference in adaptive expertise among the 3 cohorts, as measured using a head CT posttest. Secondary outcomes were (1) differences in routine expertise, (2) whether the quantity of errors during training mediated differences in adaptive expertise, and (3) the interaction between prior residency training and the learning strategies. Results: Among 212 randomized participants (mean [SD] age, 28.8 [2.0] years; 107 men [50.5%]), 70 were allocated to the difficult EMT, 71 to the easy EMT, and 71 to the EAT control cohorts; 150 participants (70.8%) completed the posttest. The difficult EMT cohort outperformed both the easy EMT and EAT cohorts on adaptive expertise cases (60.6% [95% CI, 56.1%-65.1%] vs 45.2% [95% CI, 39.9%-50.6%], vs 40.9% [95% CI, 36.0%-45.7%], respectively; P < .001), with a large effect size (η2 = 0.19). There was no significant difference in routine expertise. The difficult EMT cohort made more errors during training than the easy EMT cohort. Mediation analysis showed that the number of errors during training explained 87.2% of the difficult EMT learning strategy's effect on improving adaptive expertise (P = .01). The difficult EMT learning strategy was more effective in improving adaptive expertise for residents earlier in training, with a large effect size (η2 = 0.25; P = .002). Conclusions and Relevance: In this randomized clinical trial, the findings show that EMT is an effective method to develop physicians' adaptive expertise with cognitive skills. Trial Registration: ClinicalTrials.gov Identifier: NCT05284838.


Assuntos
Competência Clínica , Internato e Residência , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Competência Clínica/estatística & dados numéricos , Internato e Residência/métodos , Masculino , Feminino , Medicina de Emergência/educação , Adulto , Erros Médicos/prevenção & controle , Currículo , Educação de Pós-Graduação em Medicina/métodos , Aprendizagem
4.
BMC Med Educ ; 24(1): 978, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39252064

RESUMO

Young healthcare professionals and medical graduates often fall short in the practical experience necessary for handling medical emergencies. This can not only lead to strained feelings of inadequacy and insecurity among future physicians and less experienced healthcare providers in general, but also to detrimental outcomes for patients as emergency medicine demands rapid decision-making with low tolerance for errors. New didactic modalities and approaches may be needed to effectively address this shortcoming. Immersive technologies are powerful novel educational tools with untapped potential in medical training, and may be particularly suitable for simulation trainings in the high-stakes field of emergency medicine.Herein, we systematically explored the educational potential of extended reality (XR) technology, particularly virtual reality (VR), in the management of patients presenting as medical emergencies, combining the use of the STEP-VR application with an untethered hardware setup.Importantly, we aimed at studying multiple, large cohorts of senior medical students involving a total of 529 participants and collecting data over a period of two years. We assessed students' acceptance of the training through a modified questionnaire measuring device handling, content complexity, degree of immersion, learning success, and seminar design.Our results show high, sustained acceptance and ease of use across different student cohorts and subgroups, with most students finding XR/VR engaging and beneficial for acquiring emergency medicine skills. Importantly, the prevalence of simulation sickness was minimal. Moreover, no major effect of the head-mounted displays (HMDs) price range was noted with regard to the learning experience. The results underscore the potential of XR/VR capabilities in effectively enhancing medical education, particularly in areas of high-stakes clinical scenarios and emergency care, by providing realistic and reproducible immersive training environments.In summary, our findings suggest that XR/VR-based training approaches could significantly contribute to preparing future physicians for the complexities of emergency medical care, encouraging the integration of such technologies into medical curricula. However, careful consideration must be given to its suitability for all students and the practical challenges of its implementation, highlighting the need for further research to harness its full potential for medical education.


Assuntos
Medicina de Emergência , Estudantes de Medicina , Realidade Virtual , Humanos , Medicina de Emergência/educação , Estudos Longitudinais , Masculino , Feminino , Treinamento por Simulação , Competência Clínica , Educação de Graduação em Medicina/métodos , Adulto
6.
Discov Med ; 36(187): 1703-1714, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39190385

RESUMO

BACKGROUND: This study aims to facilitate parental identification of designated emergency facilities for expeditious pediatric care within the framework of Taiwan's newly implemented "regional joint defense" approach to pediatric emergency services. The research seeks to elucidate the mechanisms by which this novel system can enhance timely access to appropriate emergency care for children, potentially improving health outcomes and resource utilization in acute pediatric situations. METHODS: Factor analysis (FA) and triangular entropy matrix (TEM) analyzed the appearance, breathing and skin of pediatric assessment triangle (ABC of PAT), three types of prehospital pediatric emergence condition (PPEC), five levels of Taiwan's pediatric emergency triage (TPET), and applied the social learning theory (SLT) in educational doctrine, using experts' weighted questionnaires. RESULTS: Firstly, to address deficiencies in Taiwan's pediatric prehospital emergency medicine (PEM) system, integrating emergency medical knowledge (EMK) and pediatric life support (PLS) into medical education, staff training, and the national handbook for new parents is crucial. This equips parents to manage children's illnesses and prevent emergencies. Then, in life-threatening situations, immediate emergency room (ER) transport is vital for symptoms like whitish or purple lips, cold limbs, mottled skin, cold sweat, convulsions, dyspnea, chest dimples, weak consciousness, and oxygen saturation below 94%. Finally, for non-life-threatening emergencies, seek medical evaluation if symptoms include wheezing, chest tightness, chest pain, persistent high fever over 39 degrees with convulsions, chills, cold sweats, not eating or urinating for over 12 hours, or fever lasting more than 48 hours. CONCLUSION: Parents must remain calm and provide their baby with a sense of security while observing the development of physical symptoms. This approach enables them to effectively determine the most appropriate time to take their children to the emergency room, thereby avoiding life-threatening emergencies. Prompt and proper measures and treatments not only alleviate various discomforts caused by illness or medical emergencies but also reduce systemic distress, life-threatening situations, and unfortunate incidents before hospitalization.


Assuntos
Serviços Médicos de Emergência , Humanos , Taiwan/epidemiologia , Criança , Medicina de Emergência/educação , Medicina de Emergência/organização & administração , Cuidados para Prolongar a Vida/métodos , Pediatria/métodos , Pediatria/organização & administração , Triagem/métodos , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Pré-Escolar , Inquéritos e Questionários , Lactente
7.
BMC Med Educ ; 24(1): 924, 2024 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-39187828

RESUMO

BACKGROUND: The value of simulation in emergency medicine is indisputable because it allows training and acquisition of many technical and non-technical skills (TS and NTS). In France, there are no curriculum regarding the use of simulation as a teaching tool during emergency medicine residency. The aim of this study was to design the content of a national simulation-based curriculum for emergency medicine residency programs. METHODS: The Delphi method was conducted between March and June 2022. The questionnaire was divided into three sections: TS, NTS and clinical situations as starting points (SSPs). A panel of emergency physicians' experts on simulation education was established. An online survey was conducted in which they were asked to score, on a four-point Likert scale, the suitability of skills and SSPs to be taught through simulation courses during the emergency medicine residency. The questionnaire was revised between each round following comments or suggestions for additional items from the experts. RESULTS: Sixty-six experts completed the Delphi process. The initial questionnaire included 64 TS, 37 NTS and 103 SSPs. The experts' comments led to the addition of 12 TS, 24 NTS and 6 SSPs. Consensus was obtained after three rounds. The experts selected 24 TS and 20 NTS to be taught as a priority through simulation during the emergency medicine residency, and 15 SSPs to be used in priority. CONCLUSION: With a Delphi method, French experts in simulation-based emergency medicine education have selected 24 technical and 20 non-technical skills to be taught as a priority with simulation-based training to emergency medicine residents.


Assuntos
Currículo , Técnica Delphi , Medicina de Emergência , Internato e Residência , Treinamento por Simulação , Medicina de Emergência/educação , Humanos , França , Competência Clínica , Inquéritos e Questionários , Educação de Pós-Graduação em Medicina , Masculino , Feminino
8.
Anaesthesiologie ; 73(8): 511-520, 2024 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-39093363

RESUMO

BACKGROUND: Securing the airway in the emergency department (ED) is a high-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was a retrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications. METHOD: Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent a six-week training program including a two-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with a placed laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate. RESULTS: During the study period 499 patients were intubated by the core ED team and 28 patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527 (2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08). CONCLUSION: In clinical acute and emergency medicine, a standardized approach utilizing video laryngoscopy and a bougie following a structured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting.


Assuntos
Serviço Hospitalar de Emergência , Intubação Intratraqueal , Humanos , Intubação Intratraqueal/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Idoso , Alemanha , Medicina de Emergência/educação , Medicina de Emergência/métodos , Laringoscopia/métodos , Indução e Intubação de Sequência Rápida/métodos , Resultado do Tratamento , Serviços Médicos de Emergência/métodos , Manuseio das Vias Aéreas/métodos
9.
CJEM ; 26(9): 681-685, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39190091
10.
PLoS One ; 19(8): e0306721, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39213371

RESUMO

INTRODUCTION: Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine. MATERIALS AND METHODS: Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed. RESULTS: Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills. DISCUSSION: Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.


Assuntos
Competência Clínica , Currículo , Internato e Residência , Pediatria , Humanos , Estudos Transversais , Feminino , Masculino , Pediatria/educação , Avaliação Educacional , Medicina de Emergência/educação , Adulto
11.
Am J Emerg Med ; 84: 68-73, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39096711

RESUMO

INTRODUCTION: GPT-4, GPT-4o and Gemini advanced, which are among the well-known large language models (LLMs), have the capability to recognize and interpret visual data. When the literature is examined, there are a very limited number of studies examining the ECG performance of GPT-4. However, there is no study in the literature examining the success of Gemini and GPT-4o in ECG evaluation. The aim of our study is to evaluate the performance of GPT-4, GPT-4o, and Gemini in ECG evaluation, assess their usability in the medical field, and compare their accuracy rates in ECG interpretation with those of cardiologists and emergency medicine specialists. METHODS: The study was conducted from May 14, 2024, to June 3, 2024. The book "150 ECG Cases" served as a reference, containing two sections: daily routine ECGs and more challenging ECGs. For this study, two emergency medicine specialists selected 20 ECG cases from each section, totaling 40 cases. In the next stage, the questions were evaluated by emergency medicine specialists and cardiologists. In the subsequent phase, a diagnostic question was entered daily into GPT-4, GPT-4o, and Gemini Advanced on separate chat interfaces. In the final phase, the responses provided by cardiologists, emergency medicine specialists, GPT-4, GPT-4o, and Gemini Advanced were statistically evaluated across three categories: routine daily ECGs, more challenging ECGs, and the total number of ECGs. RESULTS: Cardiologists outperformed GPT-4, GPT-4o, and Gemini Advanced in all three groups. Emergency medicine specialists performed better than GPT-4o in routine daily ECG questions and total ECG questions (p = 0.003 and p = 0.042, respectively). When comparing GPT-4o with Gemini Advanced and GPT-4, GPT-4o performed better in total ECG questions (p = 0.027 and p < 0.001, respectively). In routine daily ECG questions, GPT-4o also outperformed Gemini Advanced (p = 0.004). Weak agreement was observed in the responses given by GPT-4 (p < 0.001, Fleiss Kappa = 0.265) and Gemini Advanced (p < 0.001, Fleiss Kappa = 0.347), while moderate agreement was observed in the responses given by GPT-4o (p < 0.001, Fleiss Kappa = 0.514). CONCLUSION: While GPT-4o shows promise, especially in more challenging ECG questions, and may have potential as an assistant for ECG evaluation, its performance in routine and overall assessments still lags behind human specialists. The limited accuracy and consistency of GPT-4 and Gemini suggest that their current use in clinical ECG interpretation is risky.


Assuntos
Cardiologistas , Eletrocardiografia , Medicina de Emergência , Humanos , Eletrocardiografia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto
12.
MedEdPORTAL ; 20: 11429, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39184363

RESUMO

Introduction: Child abuse pediatrics is an underrepresented area of medical education. To date, the available teaching materials about child abuse in MedEdPORTAL do not address burn injury, and the available materials about burn injury do not address child abuse. We created an interactive, case-based module on abusive pediatric burns to fill this educational gap. Methods: The abusive pediatric burns module was presented to a hybrid audience at a 45-minute emergency medicine grand rounds at Mayo Clinic. Participants completed a pre- and postmodule assessment to measure their confidence and knowledge pertaining to abusive pediatric burns. Results: Fifty-six attendees, from an audience primarily composed of emergency medicine physicians but also including some multidisciplinary individuals, participated in the module. The median confidence level in assessing pediatric burns for abuse showed a modest increase from 4 (interquartile range [IQR]: 2-6) to 6 (IQR: 5-8), and the proportion of participants answering knowledge questions correctly increased for every question: 18% versus 45%, 41% versus 100%, 59% versus 84%, and 72% versus 100%. Qualitative feedback from the audience was favorable. Discussion: This interactive, case-based module about abusive pediatric burns was successfully administered to an audience at emergency medicine grand rounds. Increases in confidence and knowledge were observed, and positive qualitative feedback was received.


Assuntos
Queimaduras , Maus-Tratos Infantis , Currículo , Pediatria , Humanos , Pediatria/educação , Criança , Médicos/psicologia , Competência Clínica/normas , Medicina de Emergência/educação
13.
R I Med J (2013) ; 107(9): 26-29, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39186399

RESUMO

BACKGROUND: Point-of-care ultrasound (POCUS) is a pivotal diagnostic tool for emergent conditions, yet the variable proficiency of emergency physicians (EPs) poses challenges. Inadequate skills may lead to care delays and suboptimal patient evaluation. This manuscript explores an innovative educational intervention deploying a Registered Diagnostic Medical Sonographer (RDMS) credentialed sonographer educator (SE) in a large academic Emergency Department (ED). We sought to evaluate the feasibility of using a SE to address POCUS skills deficiencies and attrition. METHODS: The study involved 26 EPs voluntarily participating in hands-on training with the SE between July 2021-June 2022. The educational sessions addressed machine operation, image acquisition, image interpretation, and electronic medical record documentation of POCUS results. Subjects who consented completed a survey on their comfort level with POCUS before and after the intervention.  Results: Survey data indicated increased comfort and competence among participants with basic machine operation, resident POCUS supervision, and ordering and documenting POCUS exams. Post-training, 44% of providers reported performing more POCUS exams, 44% reported documenting their POCUS in the EMR more often clinically, 57% were more likely to encourage residents to perform scans, and 14% were more likely to perform a POCUS before ordering a comprehensive ultrasound. The study also observed an increase in the number of scans performed post-intervention (more than double). The SE intervention addressed challenges such as resource limitations, and feedback from participants highlighted the program's positive impact, particularly in reducing intimidation and fostering a desire for further training. While self-reported data and limited survey completion pose limitations, the increase in POCUS scans and positive feedback underscore the intervention's potential.  Conclusions: This pilot study demonstrates the feasibility and initial impact of integrating a SE into an academic ED setting. Further research is warranted to assess the specific effects on provider comfort and clinical decision-making with POCUS. The findings support the value of a dedicated SE in enhancing EPs' POCUS proficiency, promoting ongoing education, and ultimately improving patient care.


Assuntos
Competência Clínica , Serviço Hospitalar de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Medicina de Emergência/educação , Feminino , Estudos de Viabilidade , Masculino , Inquéritos e Questionários
15.
Ann Emerg Med ; 84(3): 231-233, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39174211
17.
Rev Med Suisse ; 20(883): 1396-1399, 2024 Aug 21.
Artigo em Francês | MEDLINE | ID: mdl-39175287

RESUMO

The management of trauma is a significant part of emergency medicine practice, in a context where the number of sports accidents is rising steadily every year, with a total of 430,000 people affected in Switzerland in 2023 according to the Swiss Accident Prevention Bureau. In addition to the physical examination, radiological assessment is a cornerstone of diagnosis. Radiology of the musculoskeletal system is the most frequently requested paraclinical examination in these situations. The consequences of not recognizing radiological lesions may result in short-term consequences (haemorrhagic or neurological injuries) or long-term consequences (chronic pain, functional impairment). We therefore present examples of "pitfalls in radiology" frequently encountered in our daily clinical practice, and the use of additional exams.


La traumatologie fait partie intégrante de la médecine d'urgence, ce d'autant plus que chaque année les accidents de sport augmentent, avec un total de 430 000 personnes touchées en Suisse en 2023 selon le Bureau suisse de prévention des accidents. Hormis l'examen clinique, le bilan radiologique est une pierre angulaire du diagnostic. La radiologie de l'appareil locomoteur est l'examen paraclinique le plus demandé dans ces situations. Les conséquences de la non-reconnaissance de lésions radiologiques peuvent engendrer des séquelles à court terme (lésions hémorragiques ou neurologiques) ou à long terme (douleur chronique, impotence fonctionnelle). Il nous semblait ainsi important de présenter quelques « pièges en radiologie ¼, fréquemment rencontrés dans notre pratique quotidienne, et les compléments nécessaires à la pose d'un diagnostic éclairé.


Assuntos
Medicina de Emergência , Humanos , Medicina de Emergência/métodos , Medicina de Emergência/normas , Ferimentos e Lesões/diagnóstico por imagem , Suíça , Traumatologia/métodos , Traumatologia/normas , Radiografia/métodos , Radiografia/normas , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia
18.
Rev Med Suisse ; 20(883): 1414-1416, 2024 Aug 21.
Artigo em Francês | MEDLINE | ID: mdl-39175291

RESUMO

The use of ultrasound by emergency physicians is now well established. It can be integrated as an extension of the clinical examination, providing diagnostic support during consultation in the emergency department. However, its use in osteoarticular pathologies remains less frequent, despite a growing body of literature demonstrating its value in a variety of pathologies. Ultrasound is operator-dependent, so its proper use requires dedicated training. In Switzerland, training opportunities in osteoarticular ultrasound are still poorly known and not widely used by emergency physicians. This article describes the possibilities of use in the case of osteoarticular pathologies frequently encountered in emergency departments.


L'utilisation de l'échographie par les urgentistes est actuellement bien établie. Elle peut être intégrée comme extension de l'examen clinique et apporte alors une aide au diagnostic lors d'une consultation dans le service des urgences. Son utilisation pour les pathologies ostéoarticulaires reste cependant moins fréquente, malgré une littérature croissante montrant son intérêt dans des pathologies variées. L'échographie est dépendante de l'opérateur et son utilisation adéquate nécessite une formation dédiée. Les possibilités de formation à l'échographie ostéoarticulaire en Suisse restent encore peu connues et peu suivies par les médecins urgentistes. Cet article décrit les possibilités d'utilisation pour des pathologies ostéoarticulaires fréquemment rencontrées aux urgences.


Assuntos
Serviço Hospitalar de Emergência , Ultrassonografia , Humanos , Ultrassonografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Suíça , Artropatias/diagnóstico por imagem , Artropatias/diagnóstico , Medicina de Emergência/métodos , Medicina de Emergência/educação
19.
Aerosp Med Hum Perform ; 95(9): 703-708, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39169497

RESUMO

INTRODUCTION: No current astronauts have surgical training, and medical capabilities for future missions do not account for it. We sought to determine the effect of communication delays and text-based communication on emergency medicine physician (EMP) performance of a simulated surgical procedure and the ideal training paradigm for remote surgery.METHODS: In this study, 12 EMPs performed an appendectomy on a virtual reality laparoscopic simulator after tutorial. EMPs were randomized into two groups: one (bedside) group performing with bedside directing from a surgeon and the second (remote) group performing with text-based communications relayed to the surgeon after a 210-s time delay. Both groups performed a second simulated surgery 7 mo later with 240-s delay. Collected data included time to completion, number of movements, path length, economy of motion, percentage of time with appropriate camera positioning, texts sent, and major complications.RESULTS: The remote group took significantly longer to complete the task, used more total movements, had longer path length, and had significantly worse economy of motion during the initial trial. At the 7-mo simulation, there were no significant differences between the two groups. There was a nonsignificant increase in critical errors in the remote group at follow-up (50% vs. 20% of trials).DISCUSSION: EMPs are technically able to perform a surgical operation with delayed just-in-time telementoring guidance via text-based communication. However, the ideal paradigm for training non-surgeons to perform surgical operations is unclear but is likely real-time bedside training rather than remote training.Kamine TH, Siu M, Stegemann S, Formanek A, Levin D. Long round-trip time delay effects on performance of a simulated appendectomy task. Aerosp Med Hum Perform. 2024; 95(9):703-708.


Assuntos
Apendicectomia , Humanos , Apendicectomia/métodos , Fatores de Tempo , Masculino , Treinamento por Simulação/métodos , Laparoscopia/educação , Competência Clínica , Adulto , Realidade Virtual , Feminino , Astronautas , Medicina de Emergência/educação , Análise e Desempenho de Tarefas
20.
South Med J ; 117(8): 489-493, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39094799

RESUMO

OBJECTIVES: The landscape of the emergency medicine (EM) workforce has undergone significant changes recently, posing challenges for residents who are about to graduate from EM training programs. The objective of this study was to survey graduating residents' perceptions of the recent EM job market. METHODS: We conducted a cross-sectional survey study involving EM residents from programs in New York and New Jersey between August 2021 and November 2021. The survey consisted of 12 multiple-choice questions that focused on graduating EM residents' perceptions of the EM job market, its impact on their job search, and their interest in pursuing fellowship training. RESULTS: During the study period, 436 survey results were collected from 26 EM residency programs. Of the 418 respondents, 233 (56%) expressed their intention to start their job search earlier than their counterparts in previous years, as highlighted by the survey. Among respondents, 141 (76%) postgraduate year (PGY)-2, 139 (79%) PGY-3, and 47 (85%) PGY-4 residents anticipated a challenging job search. Nearly 90% of respondents believed that the coronavirus disease 2019 pandemic would affect both academic and nonacademic medical centers in terms of job openings. A total of 248 (59%) were interested in pursuing a fellowship after residency. Most residents preferred job opportunities on the East and West Coasts of the United States. CONCLUSIONS: The findings highlight the increasing competitiveness and challenges residents face in securing their first job, the declining interest in pursuing fellowships as residents progress in their training, and the geographic preferences for job opportunities.


Assuntos
Medicina de Emergência , Emprego , Internato e Residência , Humanos , Medicina de Emergência/educação , Estudos Transversais , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Inquéritos e Questionários , Emprego/estatística & dados numéricos , Feminino , Masculino , Escolha da Profissão , Adulto , New York , COVID-19/epidemiologia , New Jersey , Bolsas de Estudo/estatística & dados numéricos , Bolsas de Estudo/tendências
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