Simulation for assessment of Entrustable Professional Activities in an emergency medicine residency program.

In 2018, Canadian post-graduate Emergency Medicine (EM) programs transitioned to Competence-by-Design. Residents are now assessed using Entrustable Professional Activities (EPAs). We developed and implemented simulation for assessment to mitigate anticipated challenges with residents completing the required number of observations of resuscitation-based EPAs. Our survey of trainees who participated in these sessions suggests that it may be a feasible and acceptable method for EPA assessment.

RéSUMé: En 2018, les programmes canadiens d'études supérieures en médecine d'urgence (MU) sont passés à la Compétence par Conception. Les résidents sont désormais évalués à l'aide d'activités professionnelles confiables (APC). Nous avons développé et mis en œuvre une simulation pour l'évaluation afin d'atténuer les défis anticipés avec les résidents effectuant le nombre requis d'observations des APC basés sur la réanimation. Notre enquête auprès des stagiaires ayant participé à ces sessions suggère qu'il s'agit d'une méthode réalisable et acceptable pour l'évaluation de l'APE.

Risk of Infection and Sepsis in Pediatric Patients with Traumatic Brain Injury Admitted to Hospital Following Major Trauma.

Head injury accounts for 29% of all traumatic deaths in children. Sepsis is significantly associated with an increased risk of mortality in adult traumatic brain injury patients. In the pediatric population, this relationship is not well understood. The objective of this study was to compare the proportion of pediatric traumatic brain injury (TBI) patients and trauma patients without brain injury (NTBI) who developed sepsis or any infection during their index hospital admission. We performed a retrospective study of all trauma patients <18 years of age, admitted to trauma centres in Alberta, Canada from January 1, 2003 to December 31, 2012. Patients who died within 24 hrs of trauma (n = 147) and those with burns as the primary mechanism of injury (n = 53) were excluded. Hospital admission data for the remaining 2556 patients was analyzed. 1727 TBI patients and 829 NTBI patients were included. TBI was associated with lower odds of developing sepsis (OR 0.32 95% CI 0.14-0.77 p = 0.011). TBI was not found to be independently associated with developing any infectious complication after adjusting for confounding by Injury Severity Score (OR 1.25 95% CI 0.90-1.74 p = 0.180). These relationships warrant further study.