Emergency medicine resident perceptions of simulation-based training and assessment in competence by design.

OBJECTIVES: With the launch of competence by design (CBD) in emergency medicine (EM) in Canada, there are growing recommendations on the use of simulation for the training and assessment of residents. Many of these recommendations have been suggested by educational leaders and often exclude the resident stakeholder. This study sought to explore their experiences and perceptions of simulation in CBD. METHODS: Qualitative data were collected from November 2020 to May 2021 at McMaster University and the University of Toronto after receiving ethics approval from both sites. Eligible participants included EM residents who were interviewed by a trained interviewer using a semi-structured interview guide. All interviews were recorded, transcribed, coded, and collapsed into themes. Data analysis was guided by constructivist grounded theory. RESULTS: A total of seventeen residents participated. Thematic analysis revealed three major themes: 1) impact of CBD on resident views of simulation; 2) simulation's role in obtaining entrustable professional activities (EPAs) and filling educational gaps; and 3) conflicting feelings on the use of high-stakes simulation-based assessment in CBD. CONCLUSIONS: EM residents strongly support using simulation in CBD and acknowledge its ability to bridge educational gaps and fulfill specific EPAs. However, this study suggests some unintended consequences of CBD and conflicting views around simulation-based assessment that challenge resident perceptions of simulation as a safe learning space. As CBD evolves, educational leaders should consider these impacts when making future curricular changes or recommendations.

RéSUMé: OBJECTIFS: Avec le lancement de la compétence par conception (CPC) en médecine d'urgence (MU) au Canada, il existe des recommandations croissantes sur l'utilisation de la simulation pour la formation et l'évaluation des résidents. Beaucoup de ces recommandations ont été suggérées par des leaders éducatifs et excluent souvent la partie prenante résidente. Cette étude visait à explorer leurs expériences et leurs perceptions de la simulation dans la CPC. MéTHODES: Des données qualitatives ont été collectées de novembre 2020 à mai 2021 à l'Université McMaster et à l'Université de Toronto après avoir reçu l'approbation éthique des deux sites. Les participants éligibles étaient des résidents en MU qui ont été interviewés par un interviewer formé à l'aide d'un guide d'entretien semi-structuré. Toutes les interviews ont été enregistrées, transcrites, codées et regroupées en thèmes. L'analyse des données a été guidée par la théorie ancrée constructiviste. RéSULTATS: Au total, dix-sept résidents ont participé. L'analyse thématique a révélé trois thèmes majeurs : (1) l'impact de la CPC sur les opinions des résidents sur la simulation ; (2) le rôle de la simulation dans l'obtention des activités professionnelles confiables (APC) et le comblement des lacunes éducatives ; et (3) des sentiments contradictoires sur l'utilisation de l'évaluation basée sur la simulation à hauts enjeux dans la CPC. CONCLUSIONS: Les résidents en MU soutiennent fortement l'utilisation de la simulation dans la CPC et reconnaissent sa capacité à combler les lacunes éducatives et à remplir des APC spécifiques. Cependant, cette étude suggère quelques conséquences imprévues de la CPC et des opinions divergentes sur l'évaluation basée sur la simulation qui remettent en question les perceptions des résidents de la simulation comme un espace d'apprentissage sécuritaire. À mesure que la CPC évolue, les leaders éducatifs devraient tenir compte de ces impacts lorsqu'ils apportent des changements ou des recommandations curriculaires futurs.

MacEmerg Podcast: A Novel Initiative to Connect a Distributed Community of Practice.

BACKGROUND: Regional knowledge dissemination and information sharing is a challenge among physically divided groups of physicians. Many staff and resident physicians do not have easy access to share clinical and medical education and research information with each other in an academic setting. Our divisions of emergency medicine could benefit from a novel approach aimed at improving overall connection and collaborative engagement. INNOVATION: By harnessing the sociomateriality properties of podcasting, we could achieve the dual goals of better connecting our faculty as well as educating the audience on aspects of clinical practice and education that are especially relevant to our region. We sought to primarily draw on local expertise for content. We developed a standardized structure for our monthly releases, with each episode composed of a main faculty segment, a resident-focused segment, and a medical education segment. Accessibility to the podcast was maximized through its publication across multiple platforms and detailed individual show notes were made available. OUTCOMES: We applied logic model methodology with the intended goal of having much of our content consumed by local faculty and trainees. Using Web-based analytic data, we were able to ascertain the proportion and number of listens that occurred from within our local university-affiliated and/or catchment region. Episodes averaged 227.7 ± 67.2 listens with an overall 44.1% of those originating from within our defined region. REFLECTION: Given the number of regional listeners we are consistently reaching, we have been effective in serving to connect a widely distributed group of academic physicians. As we continue to grow the podcast, we plan on collecting quantitative data to better ascertain its effect on our stated goals.

Converting to Connect: A Rapid RE-AIM Evaluation of the Digital Conversion of a Clerkship Curriculum in the Age of COVID-19.

BACKGROUND: With the advent of the 2019 coronavirus pandemic, a decision was made to remove medical students from clinical rotations for their own safety. This forced students on a core emergency medicine (EM) rotation at McMaster University to immediately cease all in-person activities. An urgent need for a virtual curriculum emerged. METHODS: A virtual curriculum consisting of asynchronous case-based learning on Slack, ask-me-anything webinars, and online e-modules was created to fill the need. We describe a program evaluation using the RE-AIM framework and a social networking analysis of participants. RESULTS: Medical students (n = 23) and 11 facilitators (five residents, six faculty members) participated in this pilot study. Faculty members sent a mean (±SD) of 115 (±117) messages (n = 6), and mean (±SD) message counts for students and residents were 49.96 (±25; n = 23) and 39 (±38; n = 5), respectively. A total of 62,237 words were written by the participants, with a mean of 1,831 per person. Each message consisted of a mean (±SD) of 25 words (±29). Students rapidly acquitted themselves to digital technology. Using the RE-AIM framework we highlight the feasibility of a virtual curriculum, discuss demands on faculty time, and reflect on strategies to engage learners. CONCLUSIONS: The use of asynchronous digital curricula creates opportunities for faculty-resident interaction and engagement. We report the successful deployment of a viable model for undergraduate EM training for senior medical students in the COVID-19 era of physical distancing.

BET 1: Haloperidol in cannabinoid hyperemesis syndrome.

A short-cut review was carried out to establish whether haloperidol is effective at treating the symptoms of cannabinoid hyperemesis syndrome (CHS). One study was directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of that paper were tabulated. The clinical bottom line was that no controlled studies exist to report on the use of haloperidol. Alternative agents, used mainly off-label, show better promise at effectively treating symptoms of CHS based on case series and reports.

Disruption of Src Is Associated with Phenotypes Related to Williams-Beuren Syndrome and Altered Cellular Localization of TFII-I

Src is a nonreceptor protein tyrosine kinase that is expressed widely throughout the central nervous system and is involved in diverse biological functions. Mice homozygous for a spontaneous mutation in Src (Src (thl/thl) ) exhibited hypersociability and hyperactivity along with impairments in visuospatial, amygdala-dependent, and motor learning as well as an increased startle response to loud tones. The phenotype of Src (thl/thl) mice showed significant overlap with Williams-Beuren syndrome (WBS), a disorder caused by the deletion of several genes, including General Transcription Factor 2-I (GTF2I). Src phosphorylation regulates the movement of GTF2I protein (TFII-I) between the nucleus, where it is a transcriptional activator, and the cytoplasm, where it regulates trafficking of transient receptor potential cation channel, subfamily C, member 3 (TRPC3) subunits to the plasma membrane. Here, we demonstrate altered cellular localization of both TFII-I and TRPC3 in the Src mutants, suggesting that disruption of Src can phenocopy behavioral phenotypes observed in WBS through its regulation of TFII-I.

Duplication of GTF2I results in separation anxiety in mice and humans.

Duplication (dup7q11.23) and deletion (Williams syndrome) of chromosomal region 7q11.23 cause neurodevelopmental disorders with contrasting anxiety phenotypes. We found that 30% of 4- to 12-year-olds with dup7q11.23 but fewer than 5% of children with WS or in the general population met diagnostic criteria for a separation-anxiety disorder. To address the role of one commonly duplicated or deleted gene in separation anxiety, we compared mice that had varying numbers of Gtf2i copies. Relative to mouse pups with one or two Gtf2i copies, pups with additional Gtf2i copies showed significantly increased maternal separation-induced anxiety as measured by ultrasonic vocalizations. This study links the copy number of a single gene from 7q11.23 to separation anxiety in both mice and humans, highlighting the utility of mouse models in dissecting specific gene functions for genomic disorders that span many genes. This study also offers insight into molecular separation-anxiety pathways that might enable the development of targeted therapeutics.