Emergency Medicine Registrars Research Articles

Emergency Medicine Registrar’s Extracurricular Learning

BACKGROUND: Recently with the evolution of interest and electronic devices, education was changed greatly to be easier, effective, and reasonable. Emergency medicine is a sensitive part of medicine which need rapid stabilization, examination, diagnosis, and even management of the participant. AIM: In this study, we focused on emergency medicine registrars at King Saud medical city to know their preferred learning methods during extracurricular time. Furthermore, we investigated the relationship between certain demographic characteristics and preferred learning modality. METHODS: We used validation questionnaire design and tested by UTAH University in the United States of America, it was a simple survey designed to cover all important points in short time. We distributed the survey using online tool (survey monkey). RESULTS: Our study results found that podcasts was the most modality chosen by participants as beneficial and they expend their time more on podcasts. Age of participants was shown to be associated with use of internet and Google as leaning tool. We hope that researcher investigates this area of gab and future learning methods during emergency medicine doctors as well as other specialties of medicine. CONCLUSION: We found that participants chose podcasts as a learning channel more than other modalities in our study of emergency medicine registrars at all levels and their extracurricular educational programs. Age was substantially correlated with less use of Google and online searches for educational purposes.

The different preferences of learning among emergency medicine residents in Riyadh during their residency program

Objective: This study focused on emergency medicine (EM) registrars at King Saud Medical City to assess their preferred learning methods during extracurricular time. Also, the relationship between certain demographic characteristics and preferred learning modalities was investigated. Methods: In this descriptive study, a validated questionnaire designed and tested by Utah University in the United States of America was used. It was a simple survey designed to cover all important points in short time. The survey was distributed using the online tool SurveyMonkey. Results: This study results found that podcasts were the most chosen modality by participants as it was beneficial and they spent their time more on podcasts. Age of participants was shown to be associated with use of internet and Google as learning tool. Conclusion: It was found that participants chose podcasts as a learning channel more than other modalities of EM registrars at all levels and their extracurricular educational programs. Age was substantially correlated with less use of Google and online searches for educational purposes.

Knowledge and Attitude of Sudanese Emergency Registrars Towards the Use of Tissue Plasminogen Activator in the Management of Acute Ischemic Stroke.

Recent guidelines report that the administration of tissue plasminogen activator (tPA) within 4.5 hours enhances the clinical outcome of ischemic stroke. We assessed the knowledge and attitude of Sudanese emergency medicine registrars towards the use of tissue plasminogen activators in the management of acute ischemic stroke (AIS). This is a descriptive, cross-sectional, hospital-based study. The study was conducted in emergency departments at Khartoum State Hospitals in Sudan during the period from May to July 2021. The study sample was 150 emergency medicine registrars who fulfilled the inclusion criteria of the study. Data was collected by using a self-administered questionnaire as a Google form that was sent to the study participants by email. Knowledge about tPA in the management of AIS at the emergency department was poor, average, and good in 54 (36%), 55 (36.7%), and 41 (27.3%) individuals, respectively.However, there was no significant difference in overall knowledge based on age; nevertheless, good and average knowledge levels were considerably higher among females, level 3 and level 4 of training, and years of experience 5-10 years (p-value = 0.05). The overall attitude of the participants was positive 62 (41.3%), neutral 45 (30%), and negative 43 (28.7%). The positive attitude regarding tPAs for patients with AIS was significantly associated with age 30-40 years, females, levels 3 and 4 of training, and experience 5-10 years (p-value < 0.05). The overall knowledge and attitude of emergency medicine registrars were average to good, with a significant proportion of participants reporting low knowledge.The issues encountered by participants in the use of tPAs were the absence of a stroke team in hospitals, the absence of a protocol for the care pathway of AIS management in hospitals, and the absence of tPAs.

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.

The views and experiences of Zambia's emergency medicine registrars in South Africa: Lessons for the development of emergency care in Zambia.

IntroductionAlthough low- and middle-income countries (LMICs) are beginning to integrate emergency medicine (EM) specialist physicians into their healthcare systems, they must often send these trainees to other countries with established registrar programmes. Given that retention of foreign-trained EM specialist physicians is low following repatriation, there is interest in understanding their expectations and intentions when they return. This study aimed to describe the expectations of Zambia's EM registrars regarding the development of various aspects of emergency care in Zambia.MethodsIn this qualitative, descriptive study, individual telephonic interviews were conducted with current Zambian EM registrars using a semi-structured interview schedule. Recorded interviews were transcribed verbatim, validated by participants, and subjected to inductive content analysis.ResultsFour interviews were completed, representing the entire population of interest. Two key categories emerged from these discussions: that the state of emergency care in Zambia was inadequate, and that there were numerous priority areas for further developing the emergency care system. A lack of recognition of EM as a specialty, resource and training constraints in emergency units, and the lack of a formal prehospital emergency care system were prominently identified as challenges. Priority aspects that registrars hoped to focus on when developing emergency care included expanding local training and knowledge, improving the supply chain for essential medications and equipment, increasing interprofessional collaborative practice, and advocating for emergency care.ConclusionZambian EM registrars characterised the nascent emergency care system by challenges that are common in many LMICs and align with previous in-country assessments of emergency care. In order to ensure that registrars' strategies are ultimately implemented upon their return to Zambia, it is imperative they are communicated with stakeholders in-country. From there, mutual planning can occur between future EM specialists and government stakeholders, to ensure that there are mechanisms in place to facilitate dissemination.

Active learning in head and neck trauma: outcomes after an innovative educational course

Excellence in teaching and learning is fundamental to the provision of quality training for doctors and for this a sound knowledge of the principles of adult learning theory is important. We present an educational course in head and neck trauma skills for emergency medicine (EM) registrars, using the pedagogical principle of active learning. Our aim was to provide trainees with skills in the evaluation and management of hard and soft tissue injuries to the head, neck, and mouth. Active learning has been shown to provide a superior experience in classrooms, creating a ‘deep’ understanding of the material. To maximise learning, we used these principles to develop small group seminars led by a diverse range of teachers that allowed trainees to acquire hands-on skills. Questionnaires that were completed before and after the course showed an appreciable educational impact. We conclude that innovative teaching methods facilitate the sharing of knowledge that will benefit patient care.

Additional qualifications of trainees in specialist training programs in Australia

BackgroundIn Australia, the number of medical graduates per year has increased at a greater rate than the increase in the number of specialist training places. Consequently, competition for training positions is intensifying. There is anecdotal evidence to suggest that medical graduates are acquiring additional qualifications to compete with their peers Stevenson 2017 (https://insightplus.mja.com.au/2017/36/specialty-training-places-the-other-looming-crisis/). Our study investigates this phenomenon of additional credentialing and demonstrates the number and type of postgraduate and research qualifications obtained by specialists in training in Australia. This is the first study to assess the number and type of credentials acquired by registrars in each specialty and to provide insight into differences between specialities.MethodsInformation on specialists in training was obtained through the Medicine in Australia: Balancing Employment and Life (MABEL) survey conducted between 2008 and 2014. The number of any additional qualifications and specific PhD, Master’s degree, postgraduate diploma/certificate and research degrees from medical school were assessed for each specialist training scheme in the database.ResultsOverall, 995 registrars representing 13 specialties were included. Just under a third (30.4%) completed a research-based degree during their medical degree and almost half (46.7%) of specialist registrars obtained further qualifications after completing medicine. A significantly higher proportion of ophthalmology (78.6%) and paediatric (67.5%) registrars, and a lower percentage of emergency medicine (36.7%) registrars, held postgraduate qualifications. Overall, 2.4% of registrars held a PhD and 10.1% held a Master’s degree. A higher percentage of either PhD or Master’s was held by ophthalmology (64.3%) and surgical (30.6%) trainees and a lower percentage by anaesthetics (6.3%) and physician trainees (7.9%). Postgraduate diplomas or certificates were most common among paediatric (41.2%) and obstetrics and gynaecology (25.6%) registrars.ConclusionThis is the first study to investigate the additional qualifications of specialists in training in Australia. Almost half of specialists in training surveyed (46.7%) have completed some form of additional study, whether it is a PhD, Master’s, postgraduate diploma/certificate or research degree from medical school. Trainees of specialist training schemes are more qualified than specialists who trained in the past Aust Fam Physician 32:92-4, 2003.

Does ambulatory and fast track allocation reduce immersion in acute and resuscitation training, and impair career satisfaction and job longevity for emergency medicine registrars?

Although dedicated sections for non-acute care in the ED is recognised to improve patient flow and reduce ED congestion, there is anecdotal feedback that it detracts from work satisfaction and potentially career longevity and sustainability. Although allocation to fast track shifts reflects contemporary emergency medicine as practiced in Australasia, it may reduce registrar immersion on acute and resuscitation training.

Effect of the introduction of C-MAC videolaryngoscopy on first-pass intubation success rates for emergency medicine registrars.

The present study investigated the impact of introducing C-MAC videolaryngoscopy as the standard method of visualising glottic structures on first-pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C-MAC videolaryngoscopy were compared. The primary outcome was first-pass intubation success rates by EM registrars. Secondary outcomes were first-pass success rates by all intubators, and incidence of any complication of intubation. There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first-pass success from 59.2% (95% confidence interval [CI] 44.1-68.8%) to 85.1% (95% CI 76.0-91.2%, P < 0.001) after the introduction of C-MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06-5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85-10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C-MAC (28.9%, 95% CI 19.9-40.0% prior to C-MAC introduction; 16.1%, 95% CI 9.7-25.3% after; P = 0.048). This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators.

Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings

BackgroundMobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs).MethodsA descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher’s exact test was applied to determine associations.ResultsA significant association was found between participants’ knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes.ConclusionsMobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.

The Hartnett Model: An effective low-resource training program that facilitates formal point-of-care ultrasound credentialing of emergency medicine trainees

Introduction Training in point-of-care ultrasound (POCUS) is embedded within the curriculum framework of the Australasian College for Emergency Medicine (ACEM). However, formal credentialing in POCUS is often problematic due to lack of supervision and feedback. Within a supportive learning environment, it is expected that trainees would be more likely to satisfy the requirements of formal credentialing, such as the Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound (CCPU). Methods The Fiona Stanley Hospital (FSH) emergency department's Hartnett Model training program was devised to address traditional deficiencies in supervision and feedback during POCUS credentialing. The primary aim of this novel program is to assist ACEM trainees to acquire CCPU modules. Six emergency medicine registrars are selected for each six-month semester of the program through a formal selection process. Successful applicants nominate two CCPU modules for completion during the term and receive dedicated non-clinical time. For three hours once a week, an emergency physician holding formal POCUS credentials supervises a pair of trainees while they perform bedside scans on patients within the FSH emergency department. During these sessions, there are also opportunities for trainees' logbook scans to be reviewed. Formative and summative assessments occur as required by the CCPU module. Results The Hartnett Model has proven to be a successful method of assisting emergency medicine trainees in obtaining CCPU credentials. Over an 18-month period starting in 2017, eighteen registrars and four instructors were involved. All participants selected the E-FAST module; 13 chose Abdominal Aortic Aneurysm and 5 Basic Echo in Life Support. During their six-months in the training program, most trainees satisfied the requirements of both CCPU modules that they enrolled in (28/36 modules completed). Overall, the average number of scans in each module exceeded the requirements for the CCPU logbook. Approximately 40% of the scans were obtained by participants during the supervised sessions. Following their involvement in the program, trainees' perceived that undergoing POCUS training had significantly benefited their ability to manage patients. There was overwhelming support for the structure of the program. Conclusions The FSH emergency department's Hartnett 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 emergency departments around Australia.

A cross-sectional survey of child abuse management knowledge among emergency medicine personnel in Cape Town, South Africa.

IntroductionChild abuse is a common condition in the emergency centres of South Africa. It is critical for both prehospital emergency care practitioners and emergency centre-based emergency medicine registrars to be competent in screening, diagnosing, treating, and documenting child abuse. Our goal was to assess the knowledge of child abuse management in a sample of prehospital emergency care practitioners and emergency medicine registrars in Cape Town, South Africa.MethodsA mixed-methods approach of quantitative and qualitative data was used to survey a sample of 120 participants (30 emergency medicine registrars and 90 prehospital emergency care practitioners: 30 Basic Life Support, 30 Intermediate Life Support, and 30 Advanced Life Support). An expert panel created the survey to ensure content validity and survey questions were designed to assess the perceived and actual knowledge of participants. We hypothesised that there would be significantly higher levels of perceived and actual knowledge in emergency medicine registrars compared to emergency care practitioners. An open-ended question on how participants felt dealing with child abuse was qualitatively analysed using thematic analysis.ResultsThere were significant differences in the levels of perceived knowledge (58% of emergency medicine registrars agreed that they felt adequately trained overall, versus 39% of emergency care practitioners; −19% difference, 95% CI −26% to −12%) and actual knowledge (83% of emergency medicine registrars with correct answers, versus 62% of emergency care practitioners; −21% difference, 95% CI −26% to −16%) among participants. Themes that emerged from qualitative analysis included personal distress, retaliation, frustration, medical system frustration, and personal competence concerns.DiscussionSignificant perceived and actual knowledge deficits of child abuse management exist among both emergency care practitioners and emergency medicine registrars in this setting. Future interventions should address the need for guidelines and increased training opportunities to ensure the health and safety of abused children.

How Knowledge Relates to Confidence in Orthopedics and Emergency Medicine Regarding Return to Sport and Rehabilitation in Foot and Ankle Trauma

The aim of this study was to survey the knowledge of registrars in emergency medicine and orthopedics on 5 common injuries to the foot and ankle and compare this knowledge, and self-reported confidence in giving it, with that of consultants and physiotherapists of various levels of experience. An online survey was used to gather the information using scenario-based open and closed questions. A total of 102 health care professionals, who regularly deal with sports injuries, were recruited. These included consultant orthopedic surgeons with a subspecialty interest in foot and ankle surgery, orthopedic surgeons in other specialties, extended scope physiotherapy practitioners (ESPs) in foot and ankle and general musculoskeletal practice, emergency medicine consultants, emergency medicine registrars, orthopedic registrars, senior physiotherapists, and junior physiotherapists. The participants were drawn from various health care institutions in the North East of England. Consultant foot and ankle surgeons and extended scope practitioners in foot and ankle both scored significantly on knowledge of rehabilitation program design than either set of registrars. For 2 of the case scenarios, there was a significant difference in scores between either orthopedic consultants or ESPs and registrars (p < 0.05). For total score, there was a trend for extended scope practitioners to score higher than both sets of registrars, but this did not reach significance. Correlation coefficients for knowledge and self-reported confidence ranged between 0.009 and 0.33, demonstrating only weak positive linear correlation between scenario score and reported confidence in advice given. The most significant area of gaps in knowledge among the 2 groups of registrars was in the specifics of rehabilitation programs. There was markedly higher confidence with greater seniority. Registrars in emergency medicine and orthopedics are likely to benefit from case-based teaching in sports injury rehabilitation.

How Knowledge Relates to Confidence in Orthopaedics and Emergency Medicine Regarding Rehabilitation in Foot and Ankle Trauma

Category: Sports Introduction/Purpose: The aim of this study was to survey the knowledge of registrars in emergency medicine and orthopaedics on five common injuries to the foot and ankle and compare this knowledge, and self-reported confidence in giving it, with that of consultants and physiotherapists of various levels of experience. Methods: An online survey was used to gather the information using scenario based open and closed questions. A total of 102 healthcare professionals, who regularly deal with sports injuries, were recruited. This included consultant orthopaedic surgeons with a subspecialty interest in foot and ankle surgery,. orthopaedic surgeons in other specialties, extended scope physiotherapy practitioners (ESPs) in foot and ankle and general musculoskeletal practice, emergency medicine consultants, emergency medicine registrars, orthopaedic registrars, senior physiotherapists and junior physiotherapists. The participants were drawn from the various healthcare institutions in the North East of England. Results: Consultant foot and ankle surgeons and extended scope practitioners in foot and ankle both scored significantly on knowledge of rehabilitation programme design than either set of registrars. For two of the case scenarios there was a significant difference in scores between either orthopaedic consultants or ESPs and registrars (p &lt; 0.05). For total score there was a trend for extended scope practitioners to score higher than both sets of registrars but this did not reach significance. Correlation coefficients for knowledge and self-reported confidence ranged between 0.009 and 0.33, demonstrating only weak positive linear correlation between scenario score and reported confidence in advice given. Conclusion: The most significant area of gaps in knowledge amongst the two groups of registrars was in the specifics of rehabilitation programmes. There was markedly higher confidence with greater seniority, which correlated poorly with differences in specific knowledge. Registrars in emergency medicine and orthopaedics are likely to benefit from case based teaching in sports injury rehabilitation.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? Yes.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? Yes.

The Medical Boomerang: Will it come back?

ObjectivesTo explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and...

Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

BackgroundClinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs) and perceived feedback provided.MethodsSemi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes.ResultsThirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1%) granted interviews including 100% (36/36) of ED Directors, and 96.2% (25/26) of eligible DEMTs, 24% (19/81) of advanced trainee/registrars, and 17% (15/90) of interns. Most participants (61%) felt the ED was adequately supervised in general and (64.2%) that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64%) and junior staff (79%) agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback.ConclusionsConsultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

Is the current South African emergency medicine curriculum fit for purpose? An emergency medicine practice analysis

BackgroundThe aim of this study was to determine whether the current South African Emergency Medicine Curriculum is appropriate for the burden of disease seen by registrars in Cape Town Emergency...

Personal Protection during Resuscitation of Casualties Contaminated with Chemical or Biological Warfare Agents—A Survey of Medical First Receivers

The threat of mass casualties caused by an unconventional terrorist attack is a challenge for the public health system, with special implications for emergency medicine, anesthesia, and intensive care. Advanced life support of patients injured by chemical or biological warfare agents requires an adequate level of personal protection. The aim of this study was to evaluate the personal protection knowledge of emergency physicians and anesthetists who would be at the frontline of the initial health response to a chemical/biological warfare agent incident. After institutional review board approval, knowledge of personal protection measures among emergency medicine (n = 28) and anesthetics (n = 47) specialty registrars in the South Thames Region of the United Kingdom was surveyed using a standardized questionnaire. Participants were asked for the recommended level of personal protection if a chemical/biological warfare agent(s) casualty required advanced life support in the designated hospital resuscitation area. The best awareness within both groups was regarding severe acute respiratory syndrome, and fair knowledge was found regarding anthrax, plague, Ebola, and smallpox. In both groups, knowledge about personal protection requirements against chemical warfare agents was limited. Knowledge about personal protection measures for biological agents was acceptable, but was limited for chemical warfare agents. The results highlight the need to improve training and education regarding personal protection measures for medical first receivers.