Implementation of the SIMPL (Society for Improving Medical Professional Learning) performance assessment tool in the emergency department: A pilot study.

Background: Feedback and assessment are difficult to provide in the emergency department (ED) setting despite their critical importance for competency-based education, and traditional end-of-shift evaluations (ESEs) alone may be inadequate. The SIMPL (Society for Improving Medical Professional Learning) mobile application has been successfully implemented and studied in the operative setting for surgical training programs as a point-of-care tool that incorporates three assessment scales in addition to dictated feedback. SIMPL may represent a viable tool for enhancing workplace-based feedback and assessment in emergency medicine (EM). Methods: We implemented SIMPL at a 4-year EM residency program during a pilot study from March to June 2021 for observable activities such as medical resuscitations and related procedures. Faculty and residents underwent formal rater training prior to launch and were asked to complete surveys regarding the SIMPL app's content, usability, and future directions at the end of the pilot. Results: A total of 36/58 (62%) of faculty completed at least one evaluation, for a total of 190 evaluations and an average of three evaluations per faculty. Faculty initiated 130/190 (68%) and residents initiated 60/190 (32%) evaluations. Ninety-one percent included dictated feedback. A total of 45/54 (83%) residents received at least one evaluation, with an average of 3.5 evaluations per resident. Residents generally agreed that SIMPL increased the quality of feedback received and that they valued dictated feedback. Residents generally did not value the numerical feedback provided from SIMPL. Relative to the residents, faculty overall responded more positively toward SIMPL. The pilot generated several suggestions to inform the optimization of the next version of SIMPL for EM training programs. Conclusions: The SIMPL app, originally developed for use in surgical training programs, can be implemented for use in EM residency programs, has positive support from faculty, and may provide important adjunct information beyond current ESEs.

Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71.

BACKGROUND: Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. METHODS: Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned. RESULTS: Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment. CONCLUSIONS: This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block.

Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. However, the heart monitoring functions of the wearable technology can also identify other abnormalities as well. We present the first case of wearable technology identified bradycardia diagnosed as the primary presentation of complete heart block. Wearable technology has advanced significantly, but still poses questions regarding its use in screening for rare conditions. One remaining challenge is balancing the desire to screen for rare asymptomatic conditions without overburdening emergency departments with patients responding to alarms on their devices.

Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014.

OBJECTIVE: This study analyzes and compares pediatric exposures to packet and nonpacket forms of laundry and dishwasher detergents in the United States. METHODS: Data from the National Poison Data System involving exposures to laundry and dishwasher detergents among children younger than 6 years old from 2013 through 2014 were analyzed. RESULTS: There were 62 254 children younger than 6 years old exposed to laundry and dishwasher detergents from 2013 to 2014. The number of exposures to detergent increased over the study period, but the increase was greatest for laundry detergent packets (17.0%) and dishwasher detergent packets (14.0%). Eighty-five percent of children were exposed through ingestion. The odds of clinical effects (3.9-8.2), hospitalization (4.8-23.5), intubation (6.9-71.3), and serious medical outcomes (8.4-22.6) were significantly higher for laundry detergent packet exposures than for other types of detergent. There were 117 children who required intubation, and 104 of these were exposed to laundry detergent packets. There were 2 deaths, and both were associated with laundry detergent packets. CONCLUSIONS: This national study demonstrates that pediatric laundry detergent packet exposures are more severe than laundry detergent nonpacket and dishwasher detergent (packet and nonpacket) exposures. Pediatric exposures to laundry detergent packets increased by 17% during the study period nationally and should be closely monitored to assess the effectiveness of the newly adopted voluntary safety standard; this standard should be strengthened if the number of exposures does not demonstrate a substantial decrease.

A gap in patient tape storage and use practices puts patients at risk for cutaneous fungal infections.

We report a case of a cutaneous fungal infection in a 12-year-old oncology patient related to patient tape. Our facility had no established guidelines for patient tape. A survey conducted of multiple local healthcare facilities revealed no existing policies or standards of care related to tape storage or use. This reveals a gap in practice. We call for formal recommendations for tape storage and use to enhance patient safety.