AEM Education and Training

Abstract Background Challenging clinical environments faced by emergency departments (EDs) have led to operational changes including implementation of vertical care units and fast‐track units. Little is known regarding the impact of such units on resident physician clinical education. Methods A retrospective, observational study was performed at an urban quaternary care ED evaluating the effect of opening a vertical care unit with a triage physician directing lower acuity patients to be seen by physician associates (PAs)/advanced practice registered nurses (APRNs) on the following parameters: (1) percentage of patients seen by residents, (2) Emergency Severity Index (ESI) of patients seen by residents, (3) number of procedures performed by residents, (4) number of patients per shift seen by residents, (5) percentage of critical care patients seen by residents, and (6) percentage of behavioral health patients seen by residents. Results Comparing the implementation of the vertical care unit to the prior 3 months, postgraduate year (PGY)‐1 residents had greater exposure to ESI Levels 1 and 2 (odds ratio [OR] 2.15) and more critical care (OR 2.58). PGY‐2 and PGY‐3 residents had a lower exposure to ESI 1 and 2 patients (PGY‐2 OR 0.63, PGY‐3 OR 0.61) and less critical care exposure (OR 0.64 for PGY‐2 and OR 0.62 for PGY‐3) after implementation. PGY‐1 residents saw fewer behavioral health patients (OR 0.65) while the other two classes saw more (PGY‐2 OR 1.64, PGY‐3 OR 2.74). ESI 4 and 5 exposure decreased for all classes (PGY‐1 OR 0.15, PGY‐2 OR 0.86, PGY‐3 OR 0.72). No significant difference was found in the proportion of patients treated by residents ( p = 0.85) or the number of procedures performed by residents ( p = 0.25) comparing the implementation of a vertical care unit to the prior 3 months. Conclusions This study suggests no detrimental effects of vertical care unit implementation on multiple resident education outcomes including the number and acuity level of patients seen as well as procedure numbers of resident trainees. While the outcomes measured did not show significant negative effect for the resident compliment as a whole, we noted changes to the distribution of patient acuity based on PGY level. Similar assessments are recommended to determine the educational impact of comparable operational changes in other EDs.

Alina Tsyrulnik

Craig Rothenberg

Wendy W. Sun

Arjun Venkatesh

Ryan F. Coughlin

Katja Goldflam

Rohit B. Sangal

Effects of opening a vertical care area on emergency medicine resident clinical experience

开设垂直护理区对急诊医学住院医师临床经验的影响

Christian Rose

Carl Preiksaitis

AI passed the test, but can it make the rounds?

人工智能通过了测试，但它能应对现实挑战吗？

Sally A. Santen

Kimberly Lomis

Judee Richardson

John S. Andrews

David Henderson

Sanjay V. Desai

Precision education in medicine: A necessary transformation to better prepare physicians to meet the needs of their patients

精准医学教育：为更好地满足患者需求，培养医生所需的必要转变

Abstract Background Intubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PEDs). This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve PED team performance during RSI scenarios through utilization of an RSI checklist. Methods We created a checklist modeled after previously published PED checklists. PED multidisciplinary teams participated in video‐recorded SIM training sessions involving a scenario requiring intubation three times, first without interruption then while receiving our intervention of rapid‐cycle deliberate practice (RCDP) debriefing focusing on checklist utilization and team dynamics. Learners went through the scenario once more uninterrupted to apply learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention along with pre‐ and postintervention surveys. Results A total of 483 learners participated in 64 SIM training sessions, 44 of whom met inclusion criteria and were included for data analysis. Scores increased postintervention for airway management, human factors and in total. Least‐squares mean differences for total, airway, and human factors scores were 9.55 (95% confidence interval [CI] 7.24–11.85), 4.22 (95% CI 2.91–5.52), and 5.33 (95% CI 3.86–6.8), respectively, which was statistically significant with p ‐value of &lt;0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort postintervention. Conclusions This study supports the benefit of multidisciplinary SIM training with RCDP‐style methodology as an educational method for improving airway management, teamwork skills, and RSI checklist utilization for PED staff. Incorporation of additional maintenance SIM sessions for ongoing education is likely to be further beneficial and would allow evaluation of degradation of skills over time following initial training.

Kathleen M. Waters

Ruth Hwu

Mona Kulkarni

Jeffrey Okonye

Ronine Zamor

Sofia Chaudhary

Andrew Jergel

Scott Gillespie

Abby Lewis

Rachel Krieger

Vidya Menon

Geovonni Bell

Jacob Levy

Tory Prynn

Jacqueline Regan

Claire Mathai

Nandranie Goodwin

Sherita Holmes

Use of in situ simulation to improve team performance and utilization of a rapid sequence intubation checklist

使用现场模拟提高团队表现及快速顺序插管检查表的利用率

Abstract Background Emergency physicians care for most children presenting to U.S. emergency departments (EDs). Pediatric exposure during emergency medicine (EM) residency can be variable and critically ill children are rarely encountered. A recent needs assessment revealed that emergency physicians feel less prepared to manage various conditions in children and that infants, regardless of presenting complaint, pose particular challenges. Emergency physician perceptions of the experience of caring for pediatric patients have not been widely examined through a qualitative lens. Methods We designed an interview‐based qualitative study to explore emergency physician perspectives on pediatric patient care. We recruited emergency physicians who graduated from residency in 2015–2019 and all rotated through the same large tertiary children's hospital. Four trained interviewers conducted in‐depth, one‐on‐one virtual interviews. An interdisciplinary team transcribed and then coded the interviews. The team performed a conventional content analysis for themes. Recruitment continued until thematic saturation was achieved. Results Twelve participants completed interviews. These participants trained in five diverse residency programs. Likewise, the participants now practice in a variety of settings. Three major themes emerged from the data: (1) experience and exposure are key to establishing comfort caring for children; (2) simulation, pathways, and the pediatric anesthesia rotation are educationally useful; and (3) caring for children poses unique emotional challenges. Participants shared many recommendations for future pediatric education for EM trainees, including increasing autonomy and exposure to neonates and considering how care might differ in a community setting. Conclusions This interview‐based qualitative study elucidates key themes in recently graduated emergency physicians’ perceived experience of caring for children. Our findings have important educational implications for this group of emergency physicians and those who share similar experiences in training and practice.

Regina L. Toto

Eva M. Delgado

Tara Ketterer

Emily Berner

Sarah I. Landau

Molly Crowe

Angeliz Caro Monroig

Gillian Sedigh Haghighat

Cynthia J. Mollen

General emergency physician perceptions of caring for children: A qualitative interview study

普通急诊科医生对儿童护理的看法：一项定性访谈研究

Strong relationships between trainees and physician supervisors can positively influence how trainees navigate workplace learning. How trainees act and learn in clinical workplaces characterized by rapidly developing and dissolving supervisory pairings is less well understood. This study uses the emergency department (ED) to examine the impact of transient supervisory relationships on how residents approach clinical learning opportunities.

Kelsey A. Miller

Sarah C. Cavallaro

Kate Dorney

Alexander Hirsch

Michael Monuteaux

Joshua Nagler

Paths to learning: How residents navigate transience in supervisory relationships in the emergency department

学习之路：住院医师如何在急诊科的督导关系中应对变动

短名	AEM. Educ. Train.
Journal Impact	1.82
国际分区	EMERGENCY MEDICINE(Q2)

ISSN	2472-5390
h-index	23

涉及主题	医学心理学医学教育政治学法学经济计算机科学社会学数学经济增长护理部精神科统计物理生物家庭医学病理教育学内科学管理急诊科业务
出版信息	出版商: John Wiley & Sons Inc.，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2017，原创研究文献占比: 95.45%，自引率:17.60%， Gold OA占比: 11.14%

AEM Education and Training

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Effects of opening a vertical care area on emergency medicine resident clinical experience

AI passed the test, but can it make the rounds?

Precision education in medicine: A necessary transformation to better prepare physicians to meet the needs of their patients

Use of in situ simulation to improve team performance and utilization of a rapid sequence intubation checklist

General emergency physician perceptions of caring for children: A qualitative interview study

Effects of opening a vertical care area on emergency medicine resident clinical experience

AI passed the test, but can it make the rounds?

Precision education in medicine: A necessary transformation to better prepare physicians to meet the needs of their patients

Use of in situ simulation to improve team performance and utilization of a rapid sequence intubation checklist

Paths to learning: How residents navigate transience in supervisory relationships in the emergency department