A mixed-methods evaluation of a multidisciplinary point of care ultrasound program.

BACKGROUND: Point of Care Ultrasound (PoCUS) is well established within emergency medicine, however, the availability of formal training for other clinical disciplines is limited. Memorial University has established a cost-efficient, multidisciplinary PoCUS training program focusing on training residents' discipline-specific ultrasound skills. This study evaluates the skills, knowledge, and attitudes of residents who participated in the program. METHODS: Analysis was conducted using a mixed-methods, sequential exploratory approach. Initially, a focus group of seven first year residents was conducted to generate themes that were used to guide development of a survey administered to residents over a two-year period. RESULTS: Thirty residents responded to the survey (response rate 63.8%) with 53.3% meeting the training requirements for focused assessment using sonography in trauma, 43.3% for pleural effusion, 40.0% for aortic aneurysms, and 40.0% for cardiac scans. Early pregnancy assessment was the skill of least interest with 46.6% not interested. Over half the residents (53.6%) agreed or strongly agreed that a multidisciplinary program met their needs while 21.4% disagreed. The focus group found the multidisciplinary approach adequate. CONCLUSIONS: A single PoCUS curriculum has been shown to meet the needs and expectations of a majority of residents from multiple disciplines. It can enhance collaboration and bridge gaps between increasingly compartmentalized practices of medicine.

The PHOENIX: Design and Development of a Three-Dimensional-Printed Drone Prototype and Corresponding Simulation Scenario Based on the Management of Cardiac Arrest.

Sudden cardiac arrest (SCA) remains one of the most prevalent cardiovascular emergencies in the world. The development of international protocols and the use of accessible devices such as automated external defibrillators (AEDs) allowed for the standardization and organization of medical care related to SCA. When defibrillation is performed within five minutes of starting ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), the victim survival rate has increased considerably. Therefore, training healthcare professionals to use AEDs correctly is essential to improve patient outcomes and response time in the intervention. In this technical report, we advocate simulation-based education as a teaching methodology and an essential component of drone adaptation, novel technology, that can deliver AEDs to the site, as well as a training scenario to teach healthcare professionals how to operate the real-time communication components of drones and AEDs efficiently. Studies have suggested that simulation can be an effective way to train healthcare professionals. Through teaching methodology using simulation, training these audiences has the potential to reduce the response time to intervention, consequently, increasing the patient's chance of surviving.

Rural family physician perspectives on communication with urban specialists: a qualitative study.

OBJECTIVE: Communication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision making. The aim of this study was to explore rural physicians' perspectives on communication with urban specialists during consultations and referrals. SETTING: Newfoundland and Labrador, Canada. PARTICIPANTS: This qualitative study involved semistructured, one-on-one interviews with rural family physicians (n=11) with varied career stages, geographical regions, and community sizes. RESULTS: Four themes specific to communication in rural practice were identified. The themes included: (1) understanding the contexts of rural care; (2) geographical isolation and patient transfer; and (3) respectful discourse; and (4) overcoming communication challenges in referrals and consultations. CONCLUSIONS: Communication between rural family physicians and urban specialists is a critical task in providing care for rural patients. Rural physicians see value in conveying unique aspects of rural clinical practice during communication with urban specialists, including context and the complexities of patient transfers.

Pitfalls in Emergency Medicine: Survey-Based Identification of Learning Objectives for Targeted Simulation Curricula by Emergency Department Staff.

INTRODUCTION: The emergency department is a complex practice environment into which numerous factors may introduce both human and system error. Emergency physicians have to assemble and manage multidisciplinary teams with a moment's notice to manage critically ill patients. The EM training programs across Canada are diverse with considerable variation among programs. Acquisition of both high acuity low occurrence (HALO) and crisis resource management (CRM) skills are crucial to the development of proficient emergency room physicians. Physicians and allied health workers were surveyed to identify potential causes of error in local emergency departments and to find simulation-driven solutions. METHODS: An anonymous survey was prepared to evaluate potential pitfalls of emergency care in St. John's, NL, Canada. It was distributed electronically to 108 medical staff, including physicians, nurses, and postgraduate year three (PGY3) residents. Respondents were asked about their experience with simulation education, and whether or not they feel that there is an opportunity for it in postgraduate emergency medicine training. RESULTS: The response rate was 30%. Communication - with the emergency department team, consulting services, and patients - was identified as a potential topic for simulation, along with interruptions. Burnout, busy department, departmental crowding, end of shift handover, and incomplete/missing patient medical history were identified as topics that should be included in the emergency medicine curriculum. Following a review with the simulation expert panel, it was determined that end of shift handover could also be incorporated as a simulation in the existing curriculum. DISCUSSION: This survey looked at pitfalls in emergency medicine through a CRM lens. Six pitfalls were identified as important for patient safety, but not best addressed with simulation. These could be incorporated into the half-day curriculum as didactic lectures. Four important patient safety pitfalls were identified that could potentially be addressed with simulation and incorporated in the existing emergency medicine simulation curriculum.

SPIRALS: An Approach to Non-Linear Thinking for Medical Students in the Emergency Department.

Context We lack guidelines to inform the necessary components of an emergency medicine undergraduate rotation. Traditionally, clinical reasoning has been taught using linear thought processes likely not ideal for diagnostic and management decisions made in the emergency department.  Methods We used the Delphi method to obtain consensus on a set of competencies for undergraduate emergency medicine that illustrate the non-linear concepts we believe are necessary for learners. Competencies were informed by a naturalistic observational study of emergency physicians. A survey outlining these competencies was subsequently circulated to emergency physicians who rated their relative importance. Results Eleven competencies were included in Round 1, all rated within the "for consideration" for inclusion range. This was reduced to 10 competencies in Round 2, which was only marginally more definitive with respondents rating one competency in the "definite inclusion range" and the remaining in the "for consideration" range.  Conclusions This study was conducted to address a gap in the current undergraduate emergency medicine curriculum. Consensus on the relative importance of each competency was not achieved, though we believe that the competencies that arose from this study will help medical students develop the non-linear thinking processes necessary to succeed in emergency medicine.

Automated Inflating Resuscitator (AIR): Design and Development of a 3D-Printed Ventilator Prototype and Corresponding Simulation Scenario Based on the Management of a Critical COVID-19 Patient.

Recent surges in COVID-19 cases have generated an urgent global demand for ventilators. This demand has led to the development of numerous low-cost ventilation devices, but there has been less emphasis on training health professionals to use these new devices safely. The aim of this technical report is twofold: first, to describe the design and manufacturing process of the automated inflating resuscitator (AIR), a 3D-printed ventilator training device which operates on the principle of pushing a bag valve mask; second, to present a simulation scenario that can be used for training health professionals how to use this and similar, low-cost, 3D-printed ventilators in the context of ventilator shortages caused by COVID-19. To this end, the AIR was designed in an expedient manner in accordance with basic functionality established by the Medicines and Healthcare Products Regulatory Agency (United Kingdom) for provisional clinical use in light of COVID-19.

Prehospital Trauma Care: A Simulation Scenario for Rural-Based Healthcare Providers.

Trauma is a major cause of premature death and disability worldwide, with a disproportionate number of deaths occurring in rural and remote areas. Prehospital care is a key link in the chain of trauma survival and its role may be currently underestimated. Therefore, addressing deficiencies in prehospital trauma care may help to improve outcomes. Several potential solutions have been proposed to address the disparities that exist in rural prehospital trauma care, some of which focus on educational endeavors. Simulation-based medical education (SBME) is one cost-effective strategy to train healthcare providers in high-acuity, low-opportunity (HALO) scenarios, such as those encountered during major trauma. The aim of this technical report is to present a mass casualty simulation scenario that is intended for healthcare providers in rural and remote locations to refine their skills and comfort level with such cases. It emphasizes prehospital trauma management and effective communication skills among healthcare teams, which are two key elements in improving trauma outcomes.

The Importance of Personal Protective Equipment Design and Donning and Doffing Technique in Mitigating Infectious Disease Spread: A Technical Report.

During the current coronavirus pandemic, significant emphasis has been placed on the importance of mitigating nosocomial spread of coronavirus disease 2019 (COVID-19). One important consideration involves the appropriate use of effective personal protective equipment (PPE), which may reduce a healthcare provider's likelihood of becoming infected while simultaneously minimizing exposure to other patients that they care for. This may reduce demands placed on the healthcare system and help to preserve the workforce. First, the importance of PPE design cannot be underestimated, as the manufacturing process must strive to maximize protection of the user while ensuring adequate comfort. Second, it has been demonstrated that inadequate education and training can significantly impact compliance with PPE recommendations. Technique regarding donning and doffing of PPE is crucial to the protection of those who don it. The purpose of this technical report is two-fold: first, to describe some important considerations in the manufacturing and design process of face shields to maximize protection for healthcare providers, and second, to describe a simulation scenario that may be used to train healthcare workers in the appropriate donning and doffing of PPE.

Collaborative Development of a Simulation-augmented Health Education Program in Resource-challenged Regions.

Simulation-based health professional education (HPE) is widely practiced in resource-rich regions, yet it is underutilized or ineffectively delivered in resource-poor ones, particularly when we fail to consider local contexts such as infrastructure, literacy, and culture when developing educational programs. Such an approach would be an example of failure of delivery, or the inability to bring services to people whose diseases have proven therapies. It is the biggest obstacle facing global health. This paper is a review of the literature and the authors' experience in developing, delivering, and evaluating sustainable HPE programs in resource-poor regions, wherever in the world they may be.

Modelling and Manufacturing of a 3D Printed Trachea for Cricothyroidotomy Simulation.

Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. In doing so, emergency cricothyroidotomy simulation can be made accessible, accurate, cost-effective and reproducible. Three-dimensional modelling software was used in conjunction with a desktop three-dimensional (3D) printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies of tracheal anatomical configuration. This ensured that the landmarking necessary for emergency cricothyroidotomies was designed appropriately. Several revisions of the original model were made based on informal opinion from medical professionals to establish appropriate anatomical accuracy of the model for use in rural/remote cricothyroidotomy simulation. Using an entry-level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in less than three hours for only $1.70 Canadian dollars (CAD). Due to its anatomical accuracy, flexibility and durability, this model is great for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments. Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.

Emergency Management of Tension Pneumothorax for Health Professionals on Remote Cat Island Bahamas.

Patients living in remote areas have higher rates of injury-related death than those living in cities. Rural and remote health professionals working in sparsely populated places, such as Cat Island Bahamas, may have scant resources for treating emergency conditions. Local health professionals must be prepared to rely solely upon clinical judgment to perform emergency "high-stakes low-frequency" procedures while also accurately and effectively communicating with distantly located receiving specialists. However, these health providers may not recently have performed or had the opportunity to practice such emergency procedures. Telesimulation may be a useful way to teach remote practitioners both emergency procedures and communication skills. This technical report describes a simulation exercise for teaching these skills.

Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario.

Simulation has been shown to improve both learner knowledge and patient outcomes. Many emergency medicine training programs incorporate simulation into their curricula to provide learners with experiences that are rare to encounter in practice, yet performance with a high degree of competence is critical. One rare encounter, which is depicted in the report, is the management of a trauma patient who was hypothermic after falling from an expedition vessel into the cold Southern Ocean. The unique scenario presented in this technical report incorporates CanMEDS learning objectives including the communicator, health advocate, and collaborator roles. Using medical simulation facilities, marine performance simulation facilities, and a video, this scenario provides teaching that is uncommon in traditional emergency medicine training. As such, it is valuable for trainees who intend to practice rural, remote, or expedition medicine, or provide coverage for ships and marine installations.

Teaching Near and Far - Broome, Western Australia.

Broome is a remote coastal town in Western Australia. As a general practitioner working in Broome, I have been involved in the education of general practice trainee registrars both locally and remotely, as a supervisor with two different training programs.

Rural Medical Education in New Zealand.

Despite a large number of yearly medical graduates, rural New Zealand is faced with a scarcity of practicing physicians. Opportunities to learn and practice in rural settings start at the undergraduate level and extend to practicing physicians. There are a number of different programs available to facilitate rural medical education for all students and physicians. These programs will be discussed in this article.

Emergency Medicine in Remote Regions.

Rural and remote places like Sable Island (Nova Scotia) or François (Newfoundland) pose a challenge in delivering both health care and appropriate education that today's learners need to practice in a rural setting. This education can be difficult to deliver to students far from academic centers. This is especially true for learners and practitioners at offshore locations like ships, oil installations, or in the air when patients are transported via fixed wing aircraft or helicopter. The following editorial provides a snapshot of the setting and the challenges faced while working as a physician on a ship, in remote regions.

Rural Community as Context and Teacher for Health Professions Education.

Nepal is a low-income, landlocked country located on the Indian subcontinent between China and India. The challenge of finding human resources for rural community health care settings is not unique to Nepal. In spite of the challenges, the health sector has made significant improvement in national health indices over the past half century. However, in terms of access to and quality of health services and impact, there remains a gross urban-rural disparity. The Patan Academy of Health Sciences (PAHS) has adopted a community-based education model, termed "community based learning and education" (CBLE), as one of the principal strategies and pedagogic methods. This method is linked to the PAHS mission of improving rural health in Nepal by training medical students through real-life experience in rural areas and developing a positive attitude among its graduates towards working in rural areas. This article outlines the PAHS approach of ruralizing the academy, which aligns with the concept of community engagement in health professional education. We describe how PAHS has embedded medical education in rural community settings, encouraging the learning context to be rural, fostering opportunities for community and peripheral health workers to participate in teaching-learning as well as evaluation of medical students, and involving community people in curriculum design and implementation.

Development of a Sustainable Simulator and Simulation Program for Laparoscopic Skills Training in Haiti.

Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training.