Is it Time for Wilderness Medicine Fellowships to Join the National Resident Matching Program Specialties Matching Service?

INTRODUCTION: The national resident matching program specialties matching service (SMS) fills fellowship positions for 66 subspecialties. Wilderness medicine (WM) fellowships currently do not participate in SMS; instead, WM uses an offer date to fill positions. To be successful, at least 75% of the available positions within a subspecialty must be within the SMS match. METHODS: All 13 civilian WM fellowship directors recruiting for academic year (AY) 2019 to 2020 and WM fellowship alumni were surveyed regarding future participation in the SMS. Estimation of the performance of SMS for WM was calculated using data published by the national resident matching program. RESULTS: Fellowship directors from all 13 civilian WM fellowships and 60 fellowship alumni participated in the survey. SMS was supported by 62% (n=8) of fellowship directors and 55% (n=33) of fellows. Willingness to pay SMS fees was 54% (n=7) among fellowship directors and 60% (n=36) among fellows. Of matched applicants, 85% (n=51) obtained their top choice program. SMS, if implemented, was perceived to have no impact on matching a top choice program by 53% (n=31); however, 34% (n=20) believed SMS would improve the chance of an applicant matching higher. The match success of SMS for specialties with fewer than 30 programs is 74%. Of the 20 WM fellowship positions in AY 2019 to 2020, 16 were matched, for a success rate of 80%. CONCLUSIONS: There is insufficient support (<75%) at this time to institute an SMS match for WM. The offer date performed similarly to SMS for filling fellowship positions in AY 2019 to 2020.

The Flipped Classroom in Emergency Medicine Using Online Videos with Interpolated Questions.

BACKGROUND: Utilizing the flipped classroom is an opportunity for a more engaged classroom session. This educational approach is theorized to improve learner engagement and retention and allows for more complex learning during class. No studies to date have been conducted in the postgraduate medical education setting investigating the effects of interactive, interpolated questions in preclassroom online video material. OBJECTIVES: We created a flipped classroom for core pediatric emergency medicine (PEM) topics using recorded online video lectures for preclassroom material and interactive simulations for the in-classroom session. METHODS: Lectures were filmed and edited to include integrated questions on an online platform called Zaption. One-half of the residents viewed the lectures uninterrupted (Group A) and the remainder (Group B) viewed with integrated questions (2-6 per 5-15-min segment). Residents were expected to view the lectures prior to in-class time (total viewing time of approximately 2½ h). The 2½-h in-class session included four simulation and three procedure stations, with six PEM faculty available for higher-level management discussion throughout the stations. Total educational time of home preparation and in-class time was approximately 5 h. RESULTS: Residents performed better on the posttest as compared to the pretest, and their satisfaction was high with this educational innovation. In 2014, performance on the posttest between the two groups was similar. However, in 2015, the group with integrated questions performed better on the posttest. CONCLUSION: An online format combined with face-to-face interaction is an effective educational model for teaching core PEM topics.

Medical student perceptions on the instruction of the emergency medicine oral case presentation.

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.

Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training.

INTRODUCTION: Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting. MATERIAL AND METHODS: This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis. RESULTS: With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support" (median from 2.50 to 3.00, p = 0.010). CONCLUSION: In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.

Evaluation of the World Health Organization-International Committee of the Red Cross Basic Emergency Care course for senior medical students.

BACKGROUND: The Basic Emergency Care: Approach to the acutely ill and injured course was developed to train health care providers to recognize, stabilize, and treat critically ill patients in resource-limited settings. This study evaluates the Basic Emergency Care course as a tool for improving the emergency medicine knowledge and skills of medical students in a lower-middle income country. METHODS: This prospective study was conducted with senior medical students at the University of Nairobi School of Medicine in October 2021. Participants' knowledge was assessed with multiple choice pre- and post-course examinations. Pre- and post-course surveys assessed participants' confidence in managing acutely ill and injured patients using a 4-point Likert scale. RESULTS: A total of 30 students from the graduating medical school class participated in the study. Post-course examination scores (mean 94.5%, range 80-100%) showed a significant improvement (p < 0.05) compared to pre-course examination scores (mean 82%, range 64-96%). Participants' comfort and confidence in providing emergency care and performing critical emergency skills significantly increased (p < 0.05) between the pre- and post-course surveys. CONCLUSION: These findings suggest that the Basic Emergency Care course is effective in providing senior medical students with basic emergency medicine knowledge and increasing their confidence to identify and address life-threatening conditions prior to their intern year.

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.

How to Use TeleSimBox "Off the Shelf" to Connect Remote Content Experts With In-Person Simulation Participants.

In this technical report, we describe how to use TeleSimBox to run a remotely facilitated simulation to connect the facilitator with learners at a distant site. This method was developed to comply with safety measures imposed during the coronavirus disease-19 (COVID-19) pandemic to reduce the risk of viral exposure and transmission. Here, we present one example where a telesimulation naïve facilitator was trained as an in-person facilitator to enable the in-situ medical student and resident learners to participate in a pediatric emergency simulation exercise remotely guided by an off-site content expert. The case of neonatal shock was run five times during a half-day emergency department (ED) educational program with one to four participants per session. 14/15 (93%) participants completed evaluations and felt that the simulation met the case learning objectives and that connecting with the remote facilitator was useful for their learning. Feedback from the one newly trained in-person facilitator was that the tool was easy to learn how to use quickly, and the process of connecting with a remote expert was worthwhile for learners. To grab this web-based toolkit off the proverbial shelf and successfully run a telesimulation session from start to finish took approximately one hour; 20 minutes were spent in preparation the day prior and 40 minutes to set up and run the simulations the day of. We believe that this is a low-cost, efficient, and perceived to be an effective method to connect remotely located content experts and learners to engage in a simulation-based education activity when access to in-person resources and personnel is limited.

Creating Clinical Reasoning Assessment Tools in Different Languages: Adaptation of the Pediatric Emergency Medicine Script Concordance Test to Japanese.

Introduction: Clinical reasoning is a crucial skill in the practice of pediatric emergency medicine and a vital element of the various competencies achieved during the clinical training of resident doctors. Pediatric emergency physicians are often required to stabilize patients and make correct diagnoses with limited clinical information, time and resources. The Pediatric Emergency Medicine Script Concordance Test (PEM-SCT) has been developed specifically for assessing physician's reasoning skills in the context of the uncertainties in pediatric emergency practice. In this study, we developed the Japanese version of the PEM-SCT (Jpem-SCT) and confirmed its validity by collecting relevant evidence. Methods: The Jpem-SCT was developed by translating the PEM-SCT into Japanese using the Translation, Review, Adjudication, Pretest, Documentation team translation model, which follows cross-cultural survey guidelines for proper translation and cross-cultural and linguistic equivalences between the English and Japanese version of the survey. First, 15 experienced pediatricians participated in the pre-test session, serving as a reference panel for modifying the test descriptions, incorporating Japanese context, and establishing the basis for the scoring process. Then, a 1-h test containing 60 questions was administered to 75 trainees from three academic institutions. Following data collection, we calculated the item-total correlations of the scores to optimize selection of the best items in the final version of the Jpem-SCT. The reliability of the finalized Jpem-SCT was calculated using Cronbach's α coefficient for ensuring generalizability of the evidence. We also conducted multiple regression analysis of the test score to collect evidence on validity of the extrapolation. Results: The final version of the test, based on item-total correlation data analysis, contained 45 questions. The participant's specialties were as follows: Transitional interns 12.0%, pediatric residents 56.0%, emergency medicine residents 25.3%, and PEM fellows 6.7%. The mean score of the final version of the Jpem-SCT was 68.6 (SD 9.8). The reliability of the optimized test (Cronbach's α) was 0.70. Multiple regression analysis showed that being a transitional intern was a negative predictor of test scores, indicating that clinical experience relates to performance on the Jpem-SCT. Conclusion: This pediatric emergency medicine Script Concordance Test was reliable and valid for assessing the development of clinical reasoning by trainee doctors during residency training.

Impact of an end-of-fourth-year emergency medicine bootcamp.

BACKGROUND: The final months of the fourth-year of medical school are variable in educational and clinical experience, and the effect on clinical knowledge and preparedness for residency is unclear. Specialty-specific "bootcamps" are a growing trend in medical education aimed at increasing clinical knowledge, procedural skills, and confidence prior to the start of residency. METHODS: We developed a 4-week Emergency Medicine (EM) bootcamp offered during the final month of medical school. At the conclusion of the course, participants evaluated its impact. EM residency-matched participants and non-participants were asked to self-evaluate their clinical knowledge, procedural skills and confidence 1 month into the start of residency. Program directors were surveyed to assess participants and non-participants across the same domains. A Fisher's exact test was performed to test whether responses between participants and non-participants were statistically different. RESULTS: From 2015 to 2018, 22 students participated in the bootcamp. The majority reported improved confidence, competence, and procedural skills upon completion of the course. Self-assessed confidence was significantly higher in EM-matched participants 1 month into residency compared to EM-matched non-participants (p = 0.009). Self-assessed clinical knowledge and procedural skill competency was higher in participants than non-participants but did not reach statistical significance. Program directors rated EM-matched participants higher in all domains but this difference was also not statistically significant. CONCLUSIONS: Participation in an EM bootcamp increases self-confidence at the start of residency among EM-matched residents. EM bootcamps and other specialty-specific courses at the end of medical school may ease the transition from student to clinician and may improve clinical knowledge and procedural skills.

Using a rule-based system to define error in the emergency department.

INTRODUCTION: The evaluation of peer-reviewed cases for error is key to quality assurance (QA) in emergency medicine, but defining error to ensure reviewer agreement and reproducibility remains elusive. The objective of this study was to create a consensus-based set of rules to systematically identify medical errors. METHODS: This is a prospective, observational study of all cases presented for peer review at an urban, tertiary care, academic medical center emergency department (ED) quality assurance (QA) committee between October 13, 2015, and September 14, 2016. Our hospital uses an electronic system enabling staff to self-identify QA issues for subsequent review. In addition, physician or patient complaints, 72-hour returns with admission, death within 24 hours, floor transfers to ICU < 24 hours, and morbidity and mortality conference cases are automatic triggers for review. Trained reviewers not involved in the patient's care use a structured 8-point Likert scale to assess for error and preventable or non-preventable adverse events. Cases where reviewers perceived a need for additional treatment, or that caused patient harm, are referred to a 20-member committee of emergency department leadership, attendings, residents, and nurses for consensus review. For this study, "rules" were proposed by the reviewers identifying the error and validated by consensus during each meeting. The committee then decided if a rule had been broken (error) or not broken (judgment call). If an error could not be phrased in terms of a rule broken, then it would not be considered an error. The rules were then evaluated by 2 reviewers and organized by theme into categories to determine common errors in emergency medicine. RESULTS: We identified 108 episodes of rules broken in 103 cases within a database of 920 QA reviewed cases. In cases where a rule was broken and therefore an error was scored, the following 5 major themes emerged: (1) not acquiring necessary information (eg, not completing a relevant physical exam), N = 33 (31%); (2) not acting on data that were acquired (eg, abnormal vital signs or labs), N = 25 (23%); (3) knowledge gaps by clinicians (eg, not knowing to reduce a hernia), N = 16 (15%); (4) communication gaps (eg, discharge instructions), N = 17 (16%); and (5) systems issues (eg, improper patient registration), N = 17 (16%). CONCLUSION: The development of consensus-based rules may result in a more standardized and practical definition of error in emergency medicine to be used as a QA tool and a basis for research. The most common type of rule broken was not acquiring necessary information. A rule-based definition of medical error in emergency medicine may identify key areas for risk reduction strategies, help standardize medical QA, and improve patient care and physician education.

Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents.

Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.

Emergency health education in a conflict stricken environment: A situational analysis.

INTRODUCTION: Bosasso General Hospital is located in Puntland Somalia, an area affected by prolonged civil conflict, terrorism, clan fighting and piracy. International evidence highlights that staff skills and competence may have a significant impact on patient outcomes however there has been little research on emergency education in such an austere and volatile environment. The purpose of this study therefore was to identify current practices and gaps in delivering emergency medicine education in this resource-deprived environment. METHODS: A mixed methods approach was adopted to inform convergent parallel data collection techniques including questionnaire (n = 16), key informant (n = 5) and focus group interviews (n = 16). Data analysis, following data triangulation, produced descriptive quantitative statistics of themes such as emergency care, educational provision, enablers and barriers. RESULTS: The research showed that among health care staff at the hospital, 19% of the nurses felt that visiting nurses offer some knowledge on emergency care, while 38% of knowledge was gained from visiting doctors. Regarding knowledge of emergency medicine, 88.9% of the nurses felt that emergency medicine is basically first aid. DISCUSSION: Emergency care was perceived by the majority as essentially 'first aid'. Many indicated that they received little or no regular or formal training on emergency care and related essential topics. In terms of challenges faced in delivering emergency care education demonstrated a common factor in the limited resources available which included lack of teaching materials, reading materials, online resources, health care professionals, equipment and mentors. Conclusions drawn suggest that the knowledge of emergency medicine by front line professionals is limited. Therefore, the development of field curricula, practical and theoretical training by visiting practitioners, provision of additional teaching aids, tools and equipment, integration of multiple disciplines in training and financial resource mobilisation would be beneficial in improving knowledge, attitudes and practices of emergency care.

Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States.

BACKGROUND: The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals. Hypothesis This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place. METHODS: The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training. RESULTS: Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars. CONCLUSION: There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.

Development and implementation of an asynchronous emergency medicine residency curriculum using a web-based platform.

The Residency Review Committee in Emergency Medicine requires residency programs to deliver at least 5 hours of weekly didactics. Achieving at least a 70 % average attendance rate per resident is required for residency program accreditation, and is used as a benchmark for residency graduation in our program. We developed a web-based, asynchronous curriculum to replace 1 hour of synchronous didactics, and hypothesized that the curriculum would be feasible to implement, well received by learners, and improve conference participation. This paper describes the feasibility and learner acceptability of a longitudinal asynchronous curriculum, and describes its impact on postgraduate year-1(PGY-1) resident conference participation and annual in-training examination scores. Using formal curriculum design methods, we developed modules and paired assessment exercises to replace 1 hour of weekly didactics. We measured feasibility (development and implementation time and costs) and learner acceptability (measured on an anonymous survey). We compared pre- and post-intervention conference participation and in-service training examination scores using a two sample t test. The asynchronous curriculum proved feasible to develop and implement. PGY-1 resident conference participation improved compared to the pre-intervention year (85.6 vs. 62 %; 95 % CI 0.295-0.177; p < 0.001). We are unable to detect a difference between in-training examination results in either the PGY-1 group or across all residents by the introduction of this intervention. 18/31 (58 %) residents completed the post-intervention survey. 83 % reported satisfaction with curriculum changes. Strengths of the curriculum included clarity and timeliness of assignments. Weaknesses included technical difficulties with the online platform. Our curriculum is feasible to develop and implement. Despite technical difficulties, residents report high satisfaction with this new curriculum. Among PGY-1 residents there is improved conference participation compared to the prior year.

Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education.

BACKGROUND: There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM) focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. METHODS: Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. RESULTS: During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74%) were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001). The top three highest average satisfaction scores in the new EM curriculum group were trauma workshop, bedside teaching, and emergency medical services workshop. The mean (standard deviation) satisfaction scores of those three teaching methods were 4.70 (0.50), 4.63 (0.58), and 4.60 (0.55), respectively. CONCLUSION: Teaching EM with workshops improved student satisfaction in EM education for medical students.