Not Your Typical Sore Throat-A Case Report on Delayed Complications From Cervical Spinal Surgery.

Esophageal perforation is an uncommon illness with a mortality rate as high as 50%. It is most frequently caused by iatrogenic instrumentation for both diagnostic and therapeutic purposes. Noniatrogenic spontaneous ruptures account for 15% of cases, followed by traumatic injury and rupture secondary to a foreign body.1 Sore throat is a common emergency medicine complaint with an array of causes and severity of pathology. We report a case of a sore throat resulting from esophageal perforation and prevertebral abscess as delayed complications from an anterior cervical surgery.

Development and Empirical Testing of a Novel Team Leadership Assessment Measure: A Pilot Study Using Simulated and Live Patient Encounters.

BACKGROUND: Team leadership is critical to health care resuscitation team performance. There has been increased focus on competency in team leadership behaviors; however, there is still variability in how team leadership is assessed within emergency medicine. The objective of this study was to develop and pilot a novel team leadership assessment measure for emergency medicine resuscitation teams. METHODS: Team leadership dimensions and associated behaviors were identified through a systematic literature review and expert consensus. Included behaviors were used to create behaviorally anchored rating scales, which were then revised based on subject matter expert ratings. Four raters from three different academic institutions observed 30 video-recorded resuscitations (20 simulated and 10 actual patient care resuscitations). Mean leadership scores were calculated. Intraclass coefficients (ICCs) were calculated for each item and for overall leadership scores. Leader scores for the simulation-based scenarios were compared to external variables including level of training, team process, clinical performance, and team situational awareness. The study was conducted from July 2017 through June 2018. RESULTS: Leadership scores ranged from 2.23 to 4.30 (mean [±SD] = 3.18 [±0.50]). The ICC for the overall score was 0.79 for all observations, 0.87 for simulation-based observations, and 0.24 for the patient care observations. Team leadership scores on simulation-based observations did not correlate with available external variables. CONCLUSIONS: We developed a novel team leadership assessment measure for emergency medicine resuscitation teams with supporting validity evidence, including content validity and response process. The measure demonstrated acceptable inter-rater reliability when applied to simulation-based medical resuscitations; however, this did not translate to trauma resuscitations in the actual patient care setting.

A Simulation-based Approach to Measuring Team Situational Awareness in Emergency Medicine: A Multicenter, Observational Study.

OBJECTIVES: Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA, but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine (EM) teams. METHODS: We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement. Interprofessional emergency medical teams, consisting of EM resident physicians, nurses, and medical students, were recruited from the University of Washington (Seattle, WA) and Wayne State University (Detroit, MI). Each team completed a simulated emergency resuscitation scenario. Immediately following the simulation, team members completed a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. Subject matter expert reviews and pilot testing of the TSA measure provided evidence of content and response process validity. Simulations were recorded and independently coded for team performance using a previously validated measure. The relationships between the TSA measure and other variables (team clinical performance, team perception of shared understanding, team leader effectiveness, and team experience) were explored. The TSA agreement metric was indexed by averaging the pairwise agreement for each dyad on a team and then averaging across dyads to yield agreement at the team level. For the team perception of shared understanding and team leadership effectiveness measures, individual team member scores were aggregated within a team to create a single team score. We computed descriptive statistics for all outcomes. We calculated Pearson's product-moment correlations to determine bivariate correlations between outcome variables with two-tailed significance testing (p < 0.05). RESULTS: A total of 123 participants were recruited and formed three-person teams (n = 41 teams). All teams completed the assessment scenario and postsimulation measures. TSA agreement ranged from 0.19 to 0.9 and had a mean (±SD) of 0.61 (±0.17). TSA correlated with team clinical performance (p < 0.05) but did not correlate with team perception of shared understanding, team leader effectiveness, or team experience. CONCLUSIONS: Team situational awareness supports adaptive teams and is critical for high reliability organizations such as healthcare systems. Simulation can provide a platform for research aimed at understanding and measuring TSA. This study provides a feasible method for simulation-based assessment of TSA in interdisciplinary teams that addresses prior measure limitations and is appropriate for use in highly dynamic, uncertain situations commonly encountered in emergency department systems. Future research is needed to understand the development of and interactions between individual-, team-, and system (distributed)-level cognitive processes.

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations.

OBJECTIVES: To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. DESIGN: A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. SETTING: This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. PARTICIPANTS: Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). INTERVENTIONS: Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. MEASUREMENTS: Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. MAIN RESULTS: When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. CONCLUSIONS: Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

The presence of a family witness impacts physician performance during simulated medical codes.

OBJECTIVE: To determine whether the presence and behavior of a family witness to cardiopulmonary resuscitation (CPR) impacts critical actions performed by physicians. DESIGN: This was a randomized comparison study of physicians' performance during a simulated cardiac arrest with three different family witness states. SETTING: This study was conducted at the Wayne State University Eugene Applebaum College of Pharmacy and Health Science's Center for Healthcare Simulation. SUBJECTS: Second-year and third-year emergency medicine (EM) residents from the Wayne State University Department of Emergency Medicine-affiliated residency programs and Michigan State University-affiliated EM residency programs. INTERVENTION: Thirty teams comprised of one second-year and one third-year EM resident were randomly assigned to one of the three groups: 1) no family witness; 2) a nonobstructive "quiet" family witness; and 3) a family witness displaying an overt grief reaction. MEASUREMENTS AND MAIN RESULTS: Each pair was assessed for time to critical actions (e.g., minutes to CPR and drug administration) and for resuscitation-based performance outcomes (e.g., number of shocks) during a simulated cardiac arrest. The time to critical events was similar across groups with respect to initiating CPR, attempting to intubate the patient, and pronouncing the death of the patient. However, the time to deliver the first defibrillation shock was longer for the overt reaction witness group (2.57 minutes) as compared with the quiet (1.77 minutes) and no family witness (1.67 minutes) groups. Additionally, fewer total shocks were delivered in the overt reaction witness groups (4.0 minutes) vs. the quiet (6.5 minutes) and no family witness groups (6.0 minutes). CONCLUSION: The presence of a family witness may have a significant impact on physicians' ability to perform critical actions during simulated medical resuscitations. Further study is necessary to see if this effect crosses over into real clinical practice and if training ameliorates this effect.

A randomized comparison trial of case-based learning versus human patient simulation in medical student education.

OBJECTIVES: Human patient simulation (HPS), utilizing computerized, physiologically responding mannequins, has become the latest innovation in medical education. However, no substantive outcome data exist validating the advantage of HPS. The objective of this study was to evaluate the efficacy of simulation training as compared with case-based learning (CBL) among fourth-year medical students as measured by observable behavioral actions. METHODS: A chest pain curriculum was presented during a one-month mandatory emergency medicine clerkship in 2005. Each month, students were randomized to participate in either the CBL-based or the HPS-based module. All students participated in the same end-of-clerkship chest pain objective structured clinical examination that measured 43 behaviors. Three subscales were computed: history taking, acute coronary syndrome evaluation and management, and cardiac arrest management. Mean total and subscale scores were compared across groups using a multivariate analysis of variance, with significance assessed from Hotelling's T2 statistic. RESULTS: Students were randomly assigned to CBL (n = 52) or HPS (n = 50) groups. The groups were well balanced after random assignment, with no differences in mean age (26.7 years; range, 22-44 years), gender (male, 52.0%), or emergency medicine preference for specialty training (28.4%). Self-ratings of learning styles were similar overall: 54.9% were visual learners, 7.8% auditory learners, and 37.3% kinetic learners. Results of the multivariate analysis of variance indicated no significant effect (Hotelling's T2 [3,98] = 0.053; p = 0.164) of education modality (CBL or HPS) on any subscale or total score difference in performance. CONCLUSIONS: HPS training offers no advantage to CBL as measured by medical student performance on a chest pain objective structured clinical examination.