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Teach Learn Med ; 28(3): 303-13, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27191587


PROBLEM: Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. INTERVENTION: We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. CONTEXT: We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). OUTCOME: Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. LESSONS LEARNED: Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.

Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Assistentes Sociais , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Currículo , Avaliação Educacional , Feminino , Humanos , Internato e Residência , Masculino , Programas de Rastreamento , Entrevista Motivacional , Desenvolvimento de Programas , São Francisco
J Emerg Med ; 48(3): 337-43, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25453857


BACKGROUND: The emergency medicine oral case presentation (EM OCP) is the clinician's communication tool to justify whether urgent intervention is required, to argue for ruling out emergent disease states, and to propose safe disposition plans in the context of triaging patients for medical care and prioritization of resources. The EM OCP provides the representation of the practice of emergency medicine, yet we do not know the current level of effectiveness of its instruction. OBJECTIVES: We aimed to document medical student perceptions and expectations of the instruction of the EM OCP. METHODS: We surveyed medical students from five institutions after their emergency medicine clerkship on their instruction of the EM OCP. Analysis included univariate descriptive statistics and chi-squared analyses for interactions. RESULTS: One hundred fifty-five medical students (82%) completed the survey. Most medical students reported the EM OCP to be unique compared to that of other disciplines (86%), integral to their clerkship evaluation (77%), and felt that additional teaching was required beyond their current medical school instruction (78%). A minority report being specifically taught the EM OCP (37%), that their instruction was consistent (29%), or that expectations of the EM OCP were clear (21%). Respondents felt that brief instruction during their orientation (65%) and reading with a portable summary card (45%) would improve their EM OCP skills, whereas other modalities would be less helpful. CONCLUSION: This study identifies a need for additional specific and consistent teaching of the EM OCP to medical students and their preference on how to receive this instruction.

Estágio Clínico/métodos , Educação de Graduação em Medicina/métodos , Medicina de Emergência/educação , Estudantes de Medicina , Estágio Clínico/normas , Competência Clínica , Comunicação , Educação de Graduação em Medicina/normas , Feminino , Humanos , Aprendizagem , Masculino , Determinação de Necessidades de Cuidados de Saúde , Percepção , Inquéritos e Questionários
J Emerg Med ; 43(5): 883-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19944550


BACKGROUND: In Massachusetts, patients with chronic alcohol dependence can be committed to 30 days of mandatory inpatient alcohol detoxification (MAD). STUDY OBJECTIVES: To examine the effects of MAD on the number of emergency department (ED) visits, hospital admissions, and emergency medical service (EMS) transports. METHODS: This retrospective study identified patients in our urban ED committed to MAD. We compared the number of ED visits and admissions to our hospital and Boston EMS transports to any facility in the 1, 3, and 6 months pre- and post-MAD, excluding the 30-day MAD period. Paired t tests were used for analysis of mean values across time. RESULTS: Ten subjects were enrolled. Comparing pre- and post-MAD, the mean number of ED visits fell 6.5 to 2.7 (p = 0.05) in the first month, 14.2 to 9.3 (p = 0.18) in 3 months, and 25.6 to 17.7 (p = 0.15) in 6 months. Mean number of hospital admissions declined: 1.3 to 0.1 (p = 0.03) in 1 month, 2.3 to 0.9 (p = 0.06) in 3 months, and 3.2 to 1.9 (p = 0.08) in 6 months. Mean number of EMS transports fell 4.6 to 2.3 (p = 0.21) in the first month, 9.2 to 5.6 (p = 0.14) in 3 months, and 13.9 to 10.0 (p = 0.26) in 6 months pre- and post-MAD. CONCLUSIONS: MAD was associated with an immediate reduction in ED visits and hospital admissions that did not remain statistically significant long term, and a non-significant reduction in EMS transports.

Alcoolismo/terapia , Ambulâncias/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alcoolismo/epidemiologia , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos
Emerg Med Clin North Am ; 26(1): 137-80, vii, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18249261


Neuro-ophthalmologic disorders arise from all areas of the neuro-ophthalmologic tract. They may be expressed simply as loss of vision or double vision, or as complex syndromes or systemic illnesses, depending on the location and type of lesion. Problems may occur anywhere along the visual pathway, including the brainstem, cavernous sinus, subarachnoid space, and orbital apex, and may affect adjacent structures also. A firm understanding of the neuroanatomy and neurophysiology of the eye is essential to correct diagnosis.

Doenças dos Nervos Cranianos/fisiopatologia , Nervos Cranianos , Diplopia/diagnóstico , Movimentos Oculares/fisiologia , Síndrome de Horner/etiologia , Nervo Óptico , Vias Visuais , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/terapia , Nervos Cranianos/anatomia & histologia , Nervos Cranianos/fisiologia , Técnicas de Diagnóstico Oftalmológico , Diplopia/etiologia , Diplopia/fisiopatologia , Síndrome de Horner/diagnóstico , Humanos , Nervo Óptico/anatomia & histologia , Nervo Óptico/fisiologia , Vias Visuais/anatomia & histologia , Vias Visuais/fisiologia