A Needs Assessment and Educational Intervention Addressing the Care of Sexual Assault Patients in the Emergency Department.

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.

Resident Supervision and Patient Care: A Comparative Time Study in a Community-Academic Versus a Community Emergency Department.

OBJECTIVE: The objective was to compare attending emergency physician (EP) time spent on direct and indirect patient care activities in emergency departments (EDs) with and without emergency medicine (EM) residents. METHODS: We performed an observational, time-motion study on 25 EPs who worked in a community-academic ED and a nonacademic community ED. Two observations of each EP were performed at each site. Average time spent per 240-minute observation on main-category activities are illustrated in percentages. We report descriptive statistics (median and interquartile ranges) for the number of minutes EPs spent per subcategory activity, in total and per patient. We performed a Wilcoxon two-sample test to assess differences between time spent across two EDs. RESULTS: The 25 observed EPs executed 34,358 tasks in the two EDs. At the community-academic ED, EPs spent 14.2% of their time supervising EM residents. Supervision activities included data presentation, medical decision making, and treatment. The time spent on supervision was offset by a decrease in time spent by EPs on indirect patient care (specifically communication and electronic health record work) at the community academic ED compared to the nonacademic community ED. There was no statistical difference with respect to direct patient care time expenditure between the two EDs. There was a nonstatistically significant difference in attending patient load between sites. CONCLUSIONS: EPs in our study spent 14.2% of their time (8.5 minutes/hour) supervising residents. The time spent supervising residents was largely offset by time savings related to indirect patient care activities rather than compromising direct patient care.

Mastery Learning of Video Laryngoscopy Using the Glidescope in the Emergency Department.

INTRODUCTION: According to the Accreditation Council for Graduate Medical Education emergency medicine requirements established before the popularity of video laryngoscopy (VL) use, 35 intubations are necessary for graduation. Our study aimed to establish a mastery-learning model for a skill set very different (VL) from direct laryngoscopy (DL) and to determine the number of attempts needed to achieve mastery with VL. METHODS: With the use of a randomized, controlled crossover study design, two learner groups underwent baseline testing intubating a mannequin using VL. Afterward, the intervention group received a mastery training intervention. After training, learners were required to repeat the procedure until achievement of 100% on the checklist for two consecutive attempts was achieved. After 3 months, both groups returned for retesting, and the control group received the same mastery training as the intervention group. Both groups returned for final testing after another 3 months. RESULTS: The intervention arm had an improvement in performance versus the control arm at 3 months of total time (P < 0.05). Both groups had an improvement within their groups' checklist scores at 3 months after training (P < 0.05), and within the intervention arm, this effect was sustained at 6 months (P < 0.05). There was no significant difference in the mean required attempts to demonstrate mastery (overall, 2.5; intervention, 2.75; control 2.25; P = 0.28). CONCLUSIONS: Simulation-based mastery-learning produces skill enhancement with VL that is resistant to decay across 6 months. Furthermore, although a small number of attempts are needed to achieve mastery, clinical experience did not substitute as a proxy for skill acquisition. This mastery-learning model provides skill sets that are not otherwise obtained in the clinical curriculum in a 3-month period.