Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual Battlefield Assisted Trauma Distributed Observation Kit (BATDOK).

INTRODUCTION: Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site handoffs. This is particularly important in the combat casualty care setting when a single casualty may be treated by four or more or five completely disparate teams across the roles of care. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the Air Force Research Laboratory to address this need. To support the deployment of this tool, we integrated BATDOK into a commercially available virtual reality (VR) medical simulation platform used by the U.S. Air Force and Defense Health Agency personnel in order to provide an immersive simulation training experience which included battlefield documentation. METHODS: A multidisciplinary team consisting of medical educators, VR simulation engineers, emergency physicians and pararescuemen, and BATDOK developers first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives, critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available Virtual Advancement of Learning for Operational Readiness VR Medical Simulation System and underwent developmental testing and evaluation during pararescueman training exercises at the Air Force Special Operations Command Special Operations Center for Medical Integration and Development. RESULTS AND CONCLUSIONS: The BATDOK capability was successfully implemented within the VR Medical Simulation System. The capability consisted of a virtual tablet with replicated interfaces and capabilities based on the developed specifications. These capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. The capability was found to be operational and in alignment with learning objectives and user acceptance goals.

Preparing students for residency interviews in the age of COVID: Lessons learned from a standardized video interview preparation program.

Objectives: The COVID-19 pandemic has necessitated the widescale adoption of video-based interviewing for residency applications. Video interviews have previously been used in the residency application process through the pilot program of the American Association of Medical Colleges standardized video interview (SVI). We conducted an SVI preparation program with our students over 3 years that consisted of an instructional lecture, deliberate practice in video interviewing, and targeted feedback by emergency medicine faculty. The aim of this investigation was to summarize the feedback students received on their practice SVIs to provide the guidance they need for preparing for the video interviews that will replace in-person interviews with residency programs. Methods: A retrospective thematic analysis was conducted on faculty feedback provided to students who had completed SVI practice videos in preparation for their application to an EM residency between June 2017 and July 2019. Categorized comments were also sorted by type of faculty feedback: positive reinforcement, constructive criticism, or both. Results: Forty-six medical students received 334 feedback elements from three faculty. Feedback was balanced between positive reinforcement statements and constructive criticism. Students performed well on appearance and attire, creating a proper recording environment, and response content. They needed the most guidance with the delivery of content and the technical quality of the video. Conclusions: Our results demonstrate a need for formal instruction in how to communicate effectively through the video medium. Medical educators will need to formally prepare students for tele-interviews with residency programs, with an emphasis on communication skills and techniques for improving the quality of their video presentation, including lighting and camera placement.

Beyond observation: Protocols and capabilities of an Emergency Department Observation Unit.

OBJECTIVE: Emergency Department Observation Units (Obs Units) provide a setting and a mechanism for further care of Emergency Department (ED) patients. Our hospital has a protocol-driven, type 1, complex 20 bed Obs Unit with 36 different protocols. We wanted to understand how the different protocols performed and what types of care were provided. METHODS: This was an IRB-approved, retrospective chart review study. A random 10% of ED patient charts with a "transfer to observation" order were selected monthly from October 2015 through June 2017. This database was designed to identify high and low functioning protocols based on length of stays (LOS) and admission rates. RESULTS: Over 20 months, a total of 984 patients qualified for the study. The average age was 49.5 ±â€¯17.2 years, 57.3% were women, and 32.3% were non-Caucasian. The admission rate was 23.5% with an average LOS in observation of 13.7 h [95% CI 13.3-14.1]. Thirty day return rate was 16.8% with 5.3% of the patients returning to the ED within the first 72 h. Thirty six different protocols were used, with the most common being chest pain (13.9%) and general (13.2%). Almost 70% received a consultation from another service, and 7.2% required a procedure while in observation. Procedures included fluoroscopic-guided lumbar punctures, endoscopies, dental extractions, and catheter replacements (nephrostomy, gastrostomy, and biliary tubes). CONCLUSIONS: An Obs Unit can care for a wide variety of patients who require multiple consultations, procedures, and care coordination while maintaining an acceptable length of stay and admission rate.

Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation.

Most emergency medicine (EM) residency programs provide an orientation program for their incoming interns, with the lecture being the most common education activity during this period. Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format.