Current use of simulation for EPA assessment in emergency medicine.

OBJECTIVE: Approximately five years ago, the Royal College emergency medicine programs in Canada implemented a competency-based paradigm and introduced the use of Entrustable Professional Activities (EPAs) for assessment of units of professional activity to assess trainees. Many competency-based medical education (CBME) based curricula, involve assessing for entrustment through observations of EPAs. While EPAs are frequently assessed in clinical settings, simulation is also used. This study aimed to characterize the use of simulation for EPA assessment. METHODS: A study interview guide was jointly developed by all study authors and followed best practices for survey development. A national interview was conducted with program directors or assistant program directors across all the Royal College emergency medicine programs across Canada. Interviews were conducted over Microsoft Teams, interviews were recorded and transcribed, using Microsoft Teams transcribing service. Sample transcripts were analyzed for theme development. Themes were then reviewed by co-authors to ensure they were representative of the participants' views. RESULTS: A 64.7% response rate was achieved. Simulation has been widely adopted by EM training programs. All interviewees demonstrated support for the use of simulation for EPA assessment for many reasons, however, PDs acknowledged limitations and thematic analysis revealed certain themes and tensions for using simulation for EPA assessment. Thematic analysis revealed six major themes: widespread support for the use of simulation for EPA assessment, concerns regarding the potential for EPA assessment to become a "tick- box" exercise, logistical barriers limiting the use of simulation for EPA assessment, varied perceptions about the authenticity of using simulation for EPA assessment, the potential for simulation for EPA assessment to compromise learner psychological safety, and suggestions for the optimization of use of simulation for EPA assessment. CONCLUSIONS: Our findings offer insight for other programs and specialties on how simulation for EPA assessment can best be utilized. Programs should use these findings when considering using simulation for EPA assessment.

RéSUMé: OBJECTIF: Il y a environ cinq ans, les programmes de médecine d'urgence du Collège royal au Canada ont mis en place un paradigme basé sur les compétences et ont introduit l'utilisation d'activités professionnelles confiables (APC) pour l'évaluation des unités d'activité professionnelle afin d'évaluer les stagiaires. De nombreux programmes d'enseignement médical basés sur les compétences (CBME) prévoient l'évaluation des compétences par l'observation des APC. Bien que les APC soient fréquemment évaluées en milieu clinique, la simulation est également utilisée. Cette étude visait à caractériser l'utilisation de la simulation pour l'évaluation de l'APC. MéTHODES: Un guide d'entretien d'étude a été élaboré conjointement par tous les auteurs de l'étude et a suivi les meilleures pratiques en matière d'élaboration d'enquêtes. Un entretien national a été réalisé avec les directeurs de programmes ou les directeurs adjoints de tous les programmes de médecine d'urgence du Collège royal au Canada. Les entretiens ont été menés sur Microsoft Teams, enregistrés et transcrits à l'aide du service de transcription de Microsoft Teams. Les transcriptions des échantillons ont été analysées pour développer des thèmes. Les thèmes ont ensuite été revus par les co-auteurs pour s'assurer qu'ils étaient représentatifs des points de vue des participants. RéSULTATS: Un taux de réponse de 64,7 % a été obtenu. La simulation a été largement adoptée par les programmes de formation en médecine d'urgence. Toutes les personnes interrogées se sont montrées favorables à l'utilisation de la simulation pour l'évaluation de l'APE pour de nombreuses raisons. Cependant, les DP ont reconnu des limites et l'analyse thématique a révélé certains thèmes et tensions liés à l'utilisation de la simulation pour l'évaluation de l'APC. L'analyse thématique a révélé six thèmes majeurs : un appui généralisé à l'utilisation de la simulation pour l'évaluation de l'APC, inquiétudes concernant la possibilité que l'évaluation de l'APC devienne un exercice de type « case à cocher ¼, des obstacles logistiques limitant l'utilisation de la simulation pour l'évaluation de l'APC, les perceptions variées quant à l'authenticité de l'utilisation de la simulation pour l'évaluation de l'APC, le potentiel de la simulation pour l'évaluation de l'APC de compromettre la sécurité psychologique des apprenants, et des suggestions pour l'optimisation de l'utilisation de la simulation pour l'évaluation de l'APC. CONCLUSIONS: Nos résultats offrent un aperçu à d'autres programmes et spécialités sur la meilleure façon d'utiliser la simulation pour l'évaluation de l'APC. Les programmes devraient utiliser ces résultats lorsqu'ils envisagent d'utiliser la simulation pour l'évaluation de l'APC.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education.

Introduction: Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape. Methodology: The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation-based education (SBE) and actively involved in EM residency education. Unique treatment/analysis: Through primary and secondary literature searches, the SLANG-EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self-paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments. Implications for educators: Instructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small-group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner-centered debriefing, rapid-cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner-centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student-centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, "Delivering Effective Education to the Next Generation," at the 2023 SAEM Annual Meeting.

Defective phosphatidic acid-phospholipase C signaling in diabetic cardiomyopathy.

The effects of exogenous phosphatidic acid (PA) on Ca2+ transients and contractile activity were studied in cardiomyocytes isolated from chronic streptozotocin-induced diabetic rats. In control cells, 25 microM PA induced a significant increase in active cell shortening and Ca2+ transients. PA increased IP3 generation in the control cardiomyocytes and its inotropic effects were blocked by a phospholipase C inhibitor. In cardiomyocytes from diabetic rats, PA induced a 25% decrease in active cell shortening and no significant effect on Ca2+ transients. Basal and PA-induced IP3 generation in diabetic rat cardiomyocytes was 3-fold lower as compared to control cells. Sarcolemmal membrane PLC activity was impaired. Insulin treatment of the diabetic animals resulted in a partial recovery of PA responses. Our results, therefore, identify an important defect in the PA-PLC signaling pathway in diabetic rat cardiomyocytes, which may have significant implications for heart dysfunction during diabetes.