Emergency Medicine Curriculum Research Articles

Defining an Ultrasound-guided Regional Anesthesia Curriculum for Emergency Medicine.

Ultrasound-guided regional anesthesia (UGRA) can be a powerful tool in the treatment of painful conditions commonly encountered in emergency medicine (EM) practice. UGRA can benefit patients while avoiding the risks of procedural sedation and opioid-based systemic analgesia. Despite these advantages, many EM trainees do not receive focused education in UGRA and there is no published curriculum specifically for EM physicians. The objective of this study was to identify the components of a UGRA curriculum for EM physicians. A list of potential curriculum elements was developed through an extensive literature review. An expert panel was convened that included 13 ultrasound faculty members from 12 institutions and from a variety of practice environments and diverse geographical regions. The panel voted on curriculum elements through two rounds of a modified Delphi process. The panelists voted on 178 total elements, 110 background knowledge elements, and 68 individual UGRA techniques. A high level of agreement was achieved for 65 background knowledge elements from the categories: benefits to providers and patients, indications, contraindications, risks, ultrasound skills, procedural skills, sterile technique, local anesthetics, and educational resources. Ten UGRA techniques achieved consensus: interscalene brachial plexus, supraclavicular brachial plexus, radial nerve, median nerve, ulnar nerve, serratus anterior plane, fascia iliaca, femoral nerve, popliteal sciatic nerve, and posterior tibial nerve blocks. The defined curriculum represents ultrasound expert opinion on a curriculum for training practicing EM physicians. This curriculum can be used to guide the development and implementation of more robust UGRA education for both residents and independent providers.

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.

“Hybrid” medical leadership emergency medicine training for international medical graduates

PurposeThe purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.Design/methodology/approachA shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.FindingsThe HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.Research limitations/implicationsThe HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.Practical implicationsThe HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.Originality/valueThis is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

An Education Imperative: Integrating Climate Change Into the Emergency Medicine Curriculum.

An Education Imperative: Integrating Climate Change Into the Emergency Medicine Curriculum.

Credentialing of emergency medicine trainees in point-of-care ultrasound: An effective, efficient and enjoyable model.

The Australasian College for Emergency Medicine Curriculum Framework contains numerous mentions of point-of-care ultrasound (PoCUS). However, obtaining formal PoCUS credentials is often problematic. The Fiona Stanley Hospital ED PoCUS training programme was devised to assist emergency medicine trainees to meet the credentialing requirements of the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine. Six emergency medicine registrars are selected for each 6-month semester. Successful applicants nominate two modules of Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound and receive dedicated non-clinical time. For 3 h a week, an emergency physician holding formal PoCUS credentials supervises a pair of trainees while they perform scans on ED patients. During these sessions, trainee logbooks can be reviewed and assessments occur as required by the module. Over an 18-month period, 18 emergency registrars were involved, averaging eight 3-h sessions each. All selected the Extended Focused Abdominal Scan for Trauma module, 14 chose Abdominal Aortic Aneurysm and eight chose Basic Echo in Life Support. Overall, 30 (75%) of 40 modules were completed within the trainees' 6-month semester. Just under half of logged scans were obtained during the supervised sessions. Overall, the average number of scans performed exceeded each module's logbook requirements. Trainees perceived that involvement in the programme benefited their ability to manage patients. There was overwhelming support for the structure of the programme. The Fiona Stanley Hospital ED model is effective in assisting emergency medicine trainees to gain formal PoCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many EDs around Australia and New Zealand.

44 Evaluating the Clinical Impact of a Novel Global Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize

44 Evaluating the Clinical Impact of a Novel Global Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize

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

ContextWe 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. MethodsWe 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.ResultsEleven 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. ConclusionsThis 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.

Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal.

IntroductionHigh-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment.MethodsWe created a simulation lab for medical officers and students on their emergency medicine rotation at a teaching hospital in Patan, Nepal, with 48,000 ED patient visits per year. We set up a simulation lab consisting of a room with one manikin, an intubation trainer, and a projector displaying a simulation cardiac monitor. In this environment, we ran a total of eight cases over 4 simulation days. Debriefing was done at the end of each case. At the end of the curriculum, an electronic survey was delivered to the medical officers to seek improvement for future cases.ResultsAll eight cases were well received, and learners appreciated the safe learning space and teamwork. Of note, the first simulation case that was run (the airway lab) was more difficult for learners due to lack of experience. Survey feedback included improving the debriefing content and adding further procedural skills training.DiscussionSimulation is a valuable experience for learners in any environment. Although resources may be limited abroad, a sustainable simulation lab can be constructed and potentially play a supportive role in developing an emergency medicine curriculum.

Development of an in situ simulation-based continuing professional development curriculum in pediatric emergency medicine

BackgroundContinuing professional development (CPD) activities delivered by simulation to independently practicing physicians are becoming increasingly popular. At present, the educational potential of such simulations is limited by the inability to create effective curricula for the CPD audience. In contrast to medical trainees, CPD activities lack pre-defined learning expectations and, instead, emphasize self-directed learning, which may not encompass true learning needs. We hypothesize that we could generate an interprofessional CPD simulation curriculum for practicing pediatric emergency medicine (PEM) physicians in a single-center tertiary care hospital using a deliberative approach combined with Kern’s six-step method of curriculum development.MethodsFrom a comprehensive core list of 94 possible PEM clinical presentations and procedures, we generated an 18-scenario CPD simulation curriculum. We conducted a comprehensive perceived and unperceived needs assessment on topics to include, incorporating opinions of faculty PEM physicians, hospital leadership, interprofessional colleagues, and expert opinion on patient benefit, simulation feasibility, and value of simulating the case for learning. To systematically rank items while balancing the needs of all stakeholders, we used a prioritization matrix to generate objective “priority scores.” These scores were used by CPD planners to deliberately determine the simulation curriculum contents.ResultsWe describe a novel three-step CPD simulation curriculum design method involving (1) systematic and deliberate needs assessment, (2) systematic prioritization, and (3) curriculum synthesis. Of practicing PEM physicians, 17/20 responded to the perceived learning needs survey, while 6/6 leaders responded to the unperceived needs assessment. These ranked data were input to a five-variable prioritization matrix generating priority scores. Based on local needs, the highest 18 scoring clinical presentations and procedures were selected for final inclusion in a PEM CPD simulation curriculum. An interim survey of PEM physician (21/24 respondents) opinions was collected, with 90% finding educational value with the curriculum. The curriculum includes items not identified by self-directed learning that PEM physicians thought should be included.ConclusionsWe highlight a novel methodology for PEM physicians that can be adapted by other specialities when designing their own CPD simulation curriculum. This methodology objectively considers and prioritizes the needs of practicing physicians and stakeholders involved in CPD.

A mixed methods needs assessment of pediatric emergency and critical care in Tanzanian providers: a model for curriculum development

Background There are several curricula developed to train providers in low-resource settings on how to care for critically ill and injured children, however few incorporate the unique needs, insights, and challenges faced by the providers. Using a mixed methods approach, we conducted a needs assessment to determine the most important learning issues, attitudes, and beliefs of emergency department (ED) providers at Muhimbili National Hospital (MNH) about the development of a novel pediatric emergency medicine (PEM) curriculum for their setting. Methods A retrospective, observational, analysis of a database of pediatric (<18 years old) ED visits from April 2016 to April 2017 identified the most common presenting diagnoses. Qualitative focus groups and semi-structured interviews were conducted using purposive sampling of providers. Content analysis identified emerging themes and member-checking was performed approximately 5 months later. Results Analysis of 16005 visits showed that 8 of the top 15 most common diagnoses were shared with the 15 most important topics identified by healthcare providers from the qualitative analysis; sepsis, anemia, malnutrition, congenital heart disease, pneumonia, burns, malaria, and seizures. Twenty-one healthcare providers (2 ED attending physicians, 1 pediatric attending, 5 ED residents, 9 nurses, and 4 registrars) participated and thematic saturation was achieved. Fifty-seven percent of respondents (n=13) preferred a course taught in-person, and 58% (n=15) preferred a course length of less than six months. Respondents preferred a mixed instruction approach of lectures and didactics with simulation and skills stations. Three principal perspectives on poor patient outcomes were identified; i) delayed presentation to care from a lack of recognition of disease severity and/or inappropriate or inadequate treatment; ii) poor communication and a lack of knowledge of pediatric resuscitation and critical care, and limited pediatric supplies and equipment; and iii) inadequate inpatient care despite ED stabilization. Conclusions Emergency care providers reported interest in participating in a short PEM curriculum with both live training and self-administered learning. The topics identified were concordant between participants and a database analysis, as well as previously published studies. Themes on poor patient outcomes have provided a deeper context into which the curriculum will be taught. These findings can inform future curriculum development efforts.

Bridging the Gap: Using Interspecialty High-Fidelity Simulation to Improve Skills in Adolescent Emergency Medicine.

Adolescents are attending emergency departments (EDs) in increasing numbers, accounting for 21% attendances in the United Kingdom. A recent report by the Northern Ireland Commissioner for Children and Young People highlighted deficiencies in the support offered by EDs to adolescents. The aim of this study was to develop a high-fidelity simulation-based course focused on managing common adolescent presentations to the ED. A 1-day mixed-modality course comprising of simulations, lectures, and skill stations, mapped to the pediatric and emergency medicine curriculum, was designed. The faculty developed and delivered 8 high-fidelity simulations. Precourse and immediate postcourse questionnaires were used to assess confidence levels and gain qualitative data. Delayed feedback was collected at 3 months. There were 36 participants; 86% (n = 31) completed the precourse feedback, 96% (n = 34) completed the postcourse feedback, and 47% (n = 17) completed the delayed feedback. There was a statistically significant increase in self-reported confidence across all domains with a median increase of 21.25% immediately, sustained at 20% on delayed 3-month feedback. Qualitative feedback noted a change in practice, "I used (the knowledge) regularly while working in children's A + E." This was a feasible, high-fidelity simulation-based study day covering the key components of adolescent medicine. The sustained increase in confidence at 3 months and the positive qualitative and quantitative feedback are supportive of the use of simulation to improve adolescent emergency care.

Defining a Focused Pediatric Emergency Medicine Curriculum for Emergency Medicine Residents: A Case Study at Michigan Medicine.

Emergency medicine (EM) is dedicated to the treatment of urgent and emergent illness requiring physicians to evaluate, treat, and diagnose patients of all ages. EM residency provides the foundation of knowledge enabling trainees to care for any patient. However, specific pediatric curriculum guidance from governing bodies is limited. The literature includes two potential curricula that are cumbersome to implement. Our primary objective was to identify the components of this curricula that were specific to pediatric emergency medicine (PEM). Secondary objectives were to provide a methods framework and to compare the results with the American Board of Emergency Medicine Model of Clinical Practice (EM Model). With the modified Delphi technique, iterative rounds of expert panels sought to reach consensus on PEM-specific topics. We utilized the published curricula as the foundation and focused this list using a group of local experts. Predetermined consensus was defined as 80% agreement. The literature-derived list of 190 topics was reviewed by the expert panel. Experts identified 92 PEM-specific topics, and the remaining 98 topics were deemed adequately covered by general EM curricula. All topics reached consensus after three rounds. The final list was sorted in accordance with the EM Model categories. Redundant topics were consolidated resulting in 68 PEM topics. Of these 68 topics, we identified 20 topics (five of which are critical) that were incompletely covered by the EM Model. Emergency medicine residency programs should focus their PEM curriculum by deliberately assessing their coverage of key PEM topics. The methods of this study can be replicated to yield locally applicable results in other EM programs. Additionally, the next iteration of the EM Model of Clinical Practice should inform their PEM topics from the available curricula in the literature.

LO12: ClerkCast: a novel online free open access emergency medicine curriculum for medical students

Innovation Concept: Canadian medical students completing their Emergency Medicine (EM) clerkship rotations must develop approaches to undifferentiated patients. Increasingly used in postgraduate EM education, Open Educational Resources (OERs) are a convenient and flexible solution to meeting medical student educational needs on their EM rotation. We hoped to supplement Canadian medical student EM education through the development of ‘ClerkCast’, a novel OER and podcast-based curriculum on CanadiEM.org. Methods: We utilized the Kern Six Step approach to curriculum development for ‘ClerkCast’. A general needs assessment involved a review of available OERs and identified a lack of effective EM OERs specific for medical students. A specific online needs assessment was used to determine which EM topics required further education for medical students. The survey was shared directly with key Canadian medical student and undergraduate medical educator stakeholder groups, and distributed globally through the CanadiEM social media networks. Results of the needs assessment highlighted shared perceptions of educational needs for medical students, with an emphasis on increased need for education on critical care and common EM presentations. We used the topics determined to be highest priority for the development of our first ten episodes of ‘ClerkCast’. Curriculum, Tool or Material: Podcast episodes are released from CanadiEM biweekly. Episodes are 30 to 45 min in length, and focus on cognitive approaches to a common EM presentation for medical students. Content is anchored on medical student interactions with a staff or resident EM co-host. Podcasts are supplemented by infographics and blog posts highlighting the key points from each episode. Learners are also encouraged to interact with the content through review quizzes on a provided question bank. Quality assurance of the content is provided by physician co-hosts who review episode scripts both prior to recording. Post-production feedback is elicited via comments on the curriculum's host website, CanadiEM.org, and through direct email correspondence to the ClerkCast address. Conclusion: With an ever increasing number of OERs in EM and critical care, the systematic development of new resources is important to avoid redundancies in content and medium while also addressing unmet learner needs. We describe the successful use of the Kern Six Steps for curriculum development for the creation of our novel EM OER for Canadian medical students, ‘ClerkCast’.

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States.

Background/objectivesPatients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies.Subjects/methods329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies.ResultsParticipants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians.ConclusionsMany participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.

Erratum: This Article Corrects: "Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital".

Introduction: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital. Methods: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations. Results: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group’s results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions. Conclusion: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.

Human resources for emergency care systems in Ethiopia: Challenges and triumphs.

Emergency care is in its nascency in most of the world and emergency health systems are developing throughout Africa, including Ethiopia. Ethiopia is a LMIC African nation that has committed to strengthening emergency care systems. A historical perspective provides the background of Ethiopian emergency care with the development of an emergency care taskforce to the first residency program and subsequent development of the Emergency and Critical Care Directorate. The goals of the directorate are discussed as well as their role in the development of the national integrated emergency medicine curriculum. Concurrently the development of multiple residencies as well as a nursing emergency and critical care training increased the human resources for emergency medicine. Recently, the WHO and Ministry of Health-Ethiopia have been working together to roll out an integrated emergency care system development agenda throughout the country bolstered by the recent passing of a world health assembly resolution to strengthen emergency care co-led by Ethiopia. With all the successes of Ethiopia in increasing human resources there have been both triumphs and challenges. The development of human resources for emergency care systems in Ethiopia provides insights and lessons learned to other nations on a similar pathway of strengthening emergency care systems.

Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital.

IntroductionThe World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital.MethodsFifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations.ResultsParticipant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6–16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0–4) in the nurses who received the training while the control group’s results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions.ConclusionThis pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.

A Modified Delphi Study to Prioritize Content for a Simulation-based Pediatric Curriculum for Emergency Medicine Residency Training Programs.

Pediatric training is an essential component of emergency medicine (EM) residency. The heterogeneity of pediatric experiences poses a significant challenge to training programs. A national simulation curriculum can assist in providing a standardized foundation of pediatric training experience to all EM trainees. Previously, a consensus-derived set of content for a pediatric curriculum for EM was published. This study aimed to prioritize that content to establish a pediatric simulation-based curriculum for all EM residency programs. Seventy-three participants were recruited to participate in a three-round modified Delphi project from 10 stakeholder organizations. In round 1, participants ranked 275 content items from a published set of pediatric curricular items for EM residents into one of four categories: definitely must, probably should, possibly could, or should not be taught using simulation in all residency programs. Additionally, in round 1 participants were asked to contribute additional items. These items were then added to the survey in round 2. In round 2, participants were provided the ratings of the entire panel and asked to rerank the items. Round 3 involved participants dichotomously rating the items. A total of 73 participants participated and 98% completed all three rounds. Round 1 resulted in 61 items rated as definitely must, 72 as probably should, 56 as possibly could, 17 as should not, and 99 new items were suggested. Round 2 resulted in 52 items rated as definitely must, 91 as probably should, 120 as possibly could, and 42 as should not. Round 3 resulted in 56 items rated as definitely must be taught using simulation in all programs. The completed modified Delphi process developed a consensus on 56 pediatric items that definitely must be taught using simulation in all EM residency programs (20 resuscitation, nine nonresuscitation, and 26 skills). These data will serve as a targeted needs assessment to inform the development of a standard pediatric simulation curriculum for all EM residency programs.

109 Social Emergency Medicine: Pakistan Perspective

WHO defines Social Determinants of Health (SDH) as “conditions in which people are born, grow, live, work and age, shaped by the distribution of money, power and resources at global, national and local levels.” The term “Social Emergency Medicine (SEM)” caters to the concept that emergency departments (EDs) provide resource intensive, critical care to high risk patients but also address social health determinants. In USA, ACEP has an established SEM section .with Social Medicine and Population Health Interest Group at SAEM. Fellowships in SEM also focus on incorporation of the patient’s social context into Emergency management. The Indus Hospital (TIH) is a 212 bed, tertiary care center, providing quality treatment, free of cost in Pakistan where social determinants of health result in multiple ED visits, bounce back and loss of income for both the patient and care giver. TIH is in the unique position to address SDH and affect masse, resulting in improved patient outcome. The specialty of emergency medicine (EM) in Pakistan is in its early years and lack of well established primary care has traditionally placed a huge burden on EDs. Preventive role of ED is not taught at undergraduate or postgraduate level. Bedside application of social determinants of health and using it to reach out into the community with well formulated plans will reduce the burden of disease and cost of managing it. The introduction of SEM at national level will develop emergency physicians cognizant of social determinants of health and better trained to address them. a) Collection of data on social determinants of health through ED centered studies with interventions to show improvement in SDH over one year. This data shall be shared with other hospitals in Pakistan running EM programs and presented to local and international donors to secure grants. b) US based fellowship programs in SEM will be approached for collaborative partnerships with the ED at TIH. With our history of collaborative programs, rotating international EM faculty can be engaged to provide training to our residents. c) The College of Physicians and Surgeons (CPSP), the national residency accrediting body has a well-defined EM curriculum. We have designed a three-month module based on SEM which will be used to teach and train our residents as a pilot. It will be presented to CPSP as a proposal to incorporate into the EM curriculum. This will ensure that all Emergency physicians being trained across Pakistan receive a formal education in SEM. d) Similar ED based programs that have met with success can be used as reference and models to develop our own programs. Examples of Chicago based “Better Health through Housing” and “Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage to Care) can be used to develop local programs focused on our social determinants of health. The concept of SEM is the need of the day in LMIC like Pakistan where recognizing and preventing progression of disease and the factors that influence it can be cost-effective. Resources in health care, especially in the public sector are scarce and their wise utilization has to be practiced. By focusing on the vulnerable population presenting to EDs, it is hoped that social determinants of heath can be improved and this can result in shifting the paradigm from cure to prevention

266 Implementing a Community Engagement Program for Residents at an Urban Emergency Department

Patients within urban underserved communities who present to the emergency department (ED) face many systemic factors that affect their health including documentation status, food insecurity, violence and homelessness. Resident learners caring for this population can find it challenging to address these issues. As part of a larger social emergency medicine (EM) curriculum we designed a “Day of Service” for residents to engage with community-based organizations that serve our patients. Our objectives were to describe implementation of a community engagement program for resident learners at an urban ED, describe resident-perceived utility of this program to care for patients and self-rated efficacy in caring for patients after participating in the program. We implemented a “Day of Service” during our weekly educational conference over the course of five hours. We arranged for site visits with four different community-based organizations that provide services including tattoo removal for former gang members, shelter and food services for persons with housing instability, legal services for undocumented persons, resources for victims of violence and sexual assault and primary care for homeless persons. A total of 24 residents (years one through four) participated. A post-“Day of Service” survey was sent to all participants with the following Likert scale items: 1) How useful was the experience in caring for patients in the ED? 2) The experience equipped me with ideas to contribute to patients’ health via partnerships outside of the ED. 3) I would like to have more experiences like this incorporated into my residency education. A total of 9 residents participated in the post-survey (total sample size n=9). In response to the first item, 78% (n=7) of respondents found the experience very or extremely useful while 22% (n=2) found the experience somewhat useful. For the second item 89% (n=8) agreed or strongly agreed that the experience equipped them with ideas to contribute to patients’ health via partnerships outside of the ED while 11% (n=1) disagreed. And for the remaining item 89% agreed or strongly agreed that they would like to have more experiences like this incorporated into their residency education while 11% (n=1) disagreed. We were able to successfully implement a “Day of Service” as part of our larger social EM curriculum for residents at an urban ED. Residents felt the experience was overall useful in caring for patients in our ED, felt better equipped to provide community-based resources that contribute to the health of our patients and would like to have similar experiences incorporated into their residency education. The free text sentiments also supported these sentiments, with emphasis on the importance of experiential learning and patient voice to guide and motivate social EM curriculum. We suspect our small survey sample size was due to the emailed electronic format. We plan to have a “Day of Service” similar to this one twice an academic year and will ask participants to fill out paper evaluations on the day of the program to increase our evaluation data. While our sample size was small, we believe these results demonstrate the utility of a community engagement program for residents to alleviate some of the challenges and frustrations addressing systemic factors that affect patients’ health at an urban ED.