Implementation of a monthly individualized learning plan with emergency medicine residents.

OBJECTIVES: Self-assessment and self-directed learning (SDL) are integral to developing competent physicians who are lifelong learners. Individualized learning plans (ILPs) are tools to formalize this process and allow for mentors to guide residents in developing these skills. Pediatric residencies have adopted the ILP process and have demonstrated improvement in resident SDL behavior, but to date there have been no EM residencies to adopt the ILP process into resident education. METHODS: The ILP program was designed around three key elements: (1) resident performance of self-assessment; (2) a collaborative conversation about learning needs and goals; and (3) a shared development of implementation strategies. The program was implemented with 12 PGY1 EM residents in the 2019-2020 academic year. Following an introduction to ILPs during orientation, residents met monthly with program leadership to create and reflect on ILPs. At the conclusion of the academic year, residents were surveyed about their attitude toward the ILP process and SDL. RESULTS: A total of nine residents completed the postimplementation survey. Prior to implementing the ILP program, residents universally reported that they had little to no experience with generating an ILP. Following implementation, 55% of residents described themselves as strong independent learners and 89% wanted to continue the program into their second year. CONCLUSIONS: Overall, residents felt that the ILP program helped to focus their goals, monitor their progress, and allowed them to develop a relationship with program leadership.

A Novel Task Trainer for Penile Corpus Cavernosa Aspiration.

INTRODUCTION: Priapism is a rare yet time sensitive emergency with potentially significant morbidity. A novel task trainer was developed for corpus cavernosa aspiration and phenylephrine injection. The primary aim of this study was to assess model realism and usefulness for emergency medicine resident procedural education. Secondarily, an assessment of comfort level with the procedure before and after intervention was performed. METHODS: A priapism model containing corpus cavernosa and spongiosum analogs was constructed. The models and evaluation forms were pilot tested by faculty and then tested for realism and usefulness in a sample of 49 residents after a brief training session. Secondary end points included resident comfort with cavernosa aspiration before and after the session of the model on a visual analog scale. RESULTS: Eight faculty pilot tested the procedure model and evaluated it based on a 5-point scale. They unanimously felt that the model was realistic [mean = 4.4, 95% confidence interval (CI) = 3.8-5.0] and useful for resident education (mean = 4.8, 95% CI = 4.4-5.0). The model was then evaluated for realism and usefulness in 49 residents. The model was felt to be realistic (mean = 4.3, 95% CI = 4.0-4.5) and useful for resident education (mean = 4.6, 95% CI = 4.4-4.8). Residents also noted an improvement in comfort performing the procedure before and after simulation session with the mean visual analog scale rating increasing from 34.3 to 83.8 (P < 0.001). CONCLUSIONS: An easily constructed priapism task trainer was felt to be realistic and useful for resident education. Secondarily, use of the model in a simulation session can improve resident comfort in an important and infrequent procedure.

The Effect of Noise Distraction on Emergency Medicine Resident Performance During Intubation of a Patient Simulator.

BACKGROUND: The environment in the Emergency Department (ED) is chaotic, and physicians are expected to perform procedures amongst distractions. OBJECTIVES: Our aim was to prospectively determine the effects of various levels of noise distraction on the success and time to successful intubation of a simulator. METHODS: Forty-five Emergency Medicine, Emergency Medicine/Internal Medicine, and Emergency Medicine/Family Medicine Residents were studied in background noise environments of <50 decibels (noise level 1), 60-70 decibels (noise level 2), and of >70 decibels (noise level 3). Residents attempted three intubations on a simulator in succession, with three randomized noise levels. Time, in seconds, to intubation was measured in each of the successful intubations. Generalized linear models were employed to examine associations between noise level and time to intubation by attempt. RESULTS: Time to intubation decreased with each attempt (median = 25.9, 17.9, 14.4 for attempt numbers 1, 2, and 3, respectively). Decibel noise level was not associated with time to intubation (p > 0.6) or success rate (p > 0.1). Attempt number did not modify the association between noise and time to intubation (p-for-interaction = 0.16). CONCLUSION: Noise level did not have an effect on time to intubation or intubation success rate, suggesting that noise levels in the ED do not affect provider ability to perform procedures. However, knowing that increased noise levels increase stress and impair the ability to communicate with team members, further study needs to be done to definitively conclude that noise does not affect provider performance in the ED setting.

Vomiting, diarrhea, constipation, and gastroenteritis.

Diseases that cause vomiting, diarrhea, constipation, and gastroenteritis are major problems for populations worldwide. Patients, particularly infants, elderly, and immunocompromised individuals, may present at any point in a wide spectrum of disease states, underscoring the need for the clinician to treat these ailments aggressively. Several promising new treatment modalities, from oral rehydration solutions to antiemetic therapies, have been introduced over the past decade. Future directions include the use of probiotic agents and better tolerated rehydration solutions. Gastrointestinal disease will continue to be a focus worldwide in the search for better ways to cure illnesses associated with vomiting and diarrhea.

Female authorship in emergency medicine parallels women practicing academic emergency medicine.

BACKGROUND: Studies have shown that women in emergency medicine (EM) lag behind their male counterparts in academic productivity. OBJECTIVES: We compared the proportion of female attending physicians from EM academic programs to the proportion of female first or second authors of original scientific manuscripts and case reports from four major EM journals in a single year. METHODS: We used a retrospective cross-sectional design. Original scientific manuscripts and case reports from four major EM journals published in 2005: Academic Emergency Medicine, Annals of Emergency Medicine, American Journal of Emergency Medicine, and Journal of Emergency Medicine were reviewed to determine genders of first and second authors. The proportion of female first or second authorship was then compared to the proportion of female EM attending physicians from 134 academic EM programs in the United States. Data were analyzed using Pearson's chi-squared and Clopper-Pearson binomial confidence intervals as appropriate. A p-value of ≤ 0.05 was considered significant. RESULTS: The percentage of female faculty; 940/3571 (26.32%, 95% confidence interval [CI] 24.9-27.8%) vs. the percentage of female first or second authorship 289/1123 (25.73%, 95% CI 23.3-28.4%) was not statistically significant (p = 0.562). There was no difference in the proportion of male and female authors with multiple manuscripts (p = 0.889). CONCLUSIONS: As measured by first and second authorship, there was no discrepancy between the proportion of female EM faculty and the proportion of female authorship in EM literature from 2005.

Emergency medicine resident performed bedside ultrasonography of the gallbladder in non-fasted healthy volunteers.

BACKGROUND: Gallbladder ultrasonography is a commonly performed test in the emergency department. It is unknown whether a non-fasting state alters the visualization of the gallbladder by emergency medicine (EM) residents. OBJECTIVES: We conducted this study to determine whether EM residents are able to visualize the gallbladder in volunteers who have recently consumed a fatty meal. METHODS: This study used a prospective, single-blinded, randomized controlled design. Initial scans were performed on fasting volunteers. A fatty meal was then consumed. Thirty minutes after eating, a different resident, who was unaware of whether the volunteer had eaten or fasted, performed a second scan. To control for operator bias, 10% of subjects remained fasting between scans. Student's paired-samples t-test, Pearson's chi-squared, and McNemar test were determined as appropriate. RESULTS: A total of 92 scans from 46 volunteers were analyzed. EM residents were able to visualize the gallbladder in all 40 pre-prandial scans (100%) and all 40 post-prandial scans (100%). Gallbladder area as measured in the longitudinal axis decreased 20% from a mean baseline of 11.58 +/- 4.86 cm(2) (95% confidence interval [CI] 11.17-12.98) to 9.2 +/- 5.04 cm(2) (95% CI 7.74-10.66, p = 0.0009) after food intake. Total time to scan for the fasting volunteers (110.2 s, 95% CI 84.34-136) did not change significantly from non-fasting volunteers (129.7 s, 95% CI 110.29-149.01, p = 0.153). CONCLUSIONS: EM residents are able to visualize the gallbladder in non-fasted healthy volunteers.