Emergency Medicine Resident Education Research Articles

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

AbstractIntroductionGeneration 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.MethodologyThe 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/analysisThrough 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 educatorsInstructional 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.

Determination, categorization, and hierarchy of content for a pediatric emergency medicine curriculum designed for emergency medicine residents.

Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula. The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements. We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme. We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition. Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

Utilizing a Graduated Responsibility Model for Emergency Medicine Resident Disaster Response Education

Utilizing a Graduated Responsibility Model for Emergency Medicine Resident Disaster Response Education

Enhancing Documentation in Emergency Medicine Resident Education Through Didactics and Simulation: Curriculum Development and Assessment

Enhancing Documentation in Emergency Medicine Resident Education Through Didactics and Simulation: Curriculum Development and Assessment

Pediatric disaster preparedness curriculum across emergency medicine residencies

Objective: To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training.
 Methods: National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year.
 Results: Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees’ level of knowledge/ skills with family reunification (Likert 2.09/5; chemical-biologicalradiological-nuclear explosive 2.95/5) and mass casualty preparation of the emergency department (3.3/5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7/5), lack of didactic time (3.7/5), and limited faculty knowledge, skill, or experience (3.3/5).
 Conclusion: PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.

COVID-19 Pandemic Impact on Practice and Education of Emergency Medicine Residents

Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced several aspects of medical education (ME). Objectives: We aimed to assess the perception of emergency medicine (EM) residents of COVID-19 impacts on the quality of ME and their wellness. Methods: This descriptive study was conducted in Tehran, Iran. A questionnaire consisting of 33 questions (5 on hospital experience, 5 on clinical experience, 12 on education, and 11 on wellness) and 1 open-ended question were designed based on the elements found in the existing literature. Face and content validity were determined by an expert panel. The baseline and demographic data were recorded, and the viewpoints of EM residents about different items in the questionnaire (ME and wellness) were evaluated. Results: The mean age of residents was 36.4 ± 7.3 years, and 64.8% and 71.8% of the participants were female and married, respectively. Most residents (81.7%) had a previous history of COVID-19 infection (mainly mild and outpatient). We observed that 90.1% of the residents had concerns about transmitting the virus to their families. Most residents agreed on the negative impacts of COVID-19 on the EM residency program and routine clinical care in hospitals. COVID-19 led to a decrease in the diversity of other diseases and bedside learning opportunities. They added that virtual learning and online programs were comfortable and flexible despite some unpleasant outcomes. EM residents experienced anxiety and stress due to the change in physical and social activities and sleep habits during the COVID-19 pandemic. Conclusions: Emergency medicine residents declared that despite the positive attitudes developed after the pandemic, COVID-19 had non-negligible and negative effects on ME. They were also exposed to greater anxiety and worriedness during the mentioned period.

Integration of Geriatric Education Within the American Board of Emergency Medicine Model.

Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula. Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members. The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A). All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.

Gaps in pediatric emergency medicine education of emergency medicine residents: A needs assessment of recent graduates.

More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency. This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were <5 years out from residency training. Deidentified surveys were distributed via email. A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate's satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants (p < 0.0070 and p < 0.0002) and performing endotracheal intubation (p < 0.0027), lumbar puncture (p < 0.0004), and Pediatric Advanced Life Support resuscitation (p < 0.0001). This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives.

128 Effect of COVID-19 Pandemic on Emergency Medicine Resident Education

128 Effect of COVID-19 Pandemic on Emergency Medicine Resident Education

412 Massive Hemorrhage Protocol: Emergency Medicine Resident Education Intervention

412 Massive Hemorrhage Protocol: Emergency Medicine Resident Education Intervention

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Effects of Non-physician Practitioners on Emergency Medicine Physician Resident Education.

The effects of non-physician practitioners (NPP) such as physician assistants and nurse practitioners on the education of emergency medicine (EM) residents have not previously been specifically evaluated. Emergency medicine societies have made policy statements regarding NPP presence in EM residencies without the benefit of empiric studies. A cross-sectional, mixed methods questionnaire with strong validity evidence was distributed to current EM residents who were members of a large national society, the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA), between June 4-July 5, 2021. We received 393 partial and complete responses, representing a 34% response rate. A majority of respondents (66.9%) reported that NPPs have a detracting or greatly detracting impact on their education overall. The workload in the emergency department was reported generally as lighter (45.2%) to no impact (40.1%), which was cited in narrative responses as an aspect of both enhancing and detracting from resident physician education. Non-physician practitioner postgraduate programs in EM were associated with a 14x increase in the median number of procedures forfeited over the course of the prior year (median = 7.0 vs 0.5, P<.001). Among respondents, 33.5% reported feeling "not confident at all" in their ability to report concerns about NPPs to local leadership without retribution, and 65.2% reported feeling "not confident at all" regarding confidence in the Accreditation Council for Graduate Medical Education to satisfactorily address concerns about NPPs raised in the end-of-year survey. Resident members of the AAEM/RSA reported having concerns about the effects of NPPs on their education and their confidence in being able to address the concerns.

Pain Medicine Education in Emergency Medicine Residency Programs.

Background Pain is a common complaint in the emergency department (ED), yet there is a lack of robust pain curricula in emergency medicine (EM) residency programs. In this study, we investigated pain education in EM residencies and various factors related to educational development. Methodology This was a prospective study collecting online survey results sent to Program Directors, Associate Program Directors, and Assistant Program Directors of EM residencies in the United States. Descriptive analyses with nonparametric tests were performed to investigate relationships between these factors, including educational hours, level of educational collaboration with pain medicine specialists, and multimodal therapy utilization. Results The overall individual response rate was 39.8% (252 out of 634 potential respondents), representing 164 out of 220 identified EM residencies with 110 (50%) Program Directors responding. Traditional classroom lectures were the most common modality for the delivery of pain medicine content. EM textbooks were the most common resource utilized for curriculum development. An average of 5.7 hours per year was devoted to pain education. Up to 46.8% of respondents reported poor or absent educational collaboration with pain medicine specialists. Greater collaboration levels were associated with greater hours devoted to pain education (p = 0.01), perceived resident interest in acute and chronic pain management education (p < 0.001), and resident utilization of regional anesthesia (p = <0.01). Faculty and resident interest in acute and chronic pain management education were similar to each other and high on the Likert scale, with higher scores correlating to greater hours devoted to pain education (p = 0.02 and 0.01, respectively). Faculty expertise in pain medicine was rated the most important factor in improving pain education in their programs. Conclusions Pain education is a necessity for residents to adequately treat pain in the ED, but remains challenging and undervalued. Faculty expertise was identified as a factor limiting pain education among EM residents. Collaboration with pain medicine specialists and recruitment of EM faculty with expertise in pain medicine are ways to improve pain education of EM residents.

Acute-on-Chronic Lithium Toxicity: A Simulation Case for Emergency Medicine Residents.

Simulation-based education has become standard within emergency medicine training. Toxicological clinical presentations are challenging to identify and treat in the emergency department. Recognizing that active teaching methods are superior to standard lecture for learner retention, we created an experiential simulation case for education on lithium toxicity. The case was written after an extensive literature review followed by consultation with a medical toxicologist and an expert in simulation-based education. Fifty-three residents participated in a simulation scenario involving a lithium-poisoned patient over the course of eight simulation sessions. The scenario ran approximately 10 minutes and was followed by postevent debriefing. Debriefing was facilitated by an emergency medicine attending with specialized training in simulation-based education. Following the completion of the scenario, residents received an anonymous educational quality improvement survey assessing residents' perception of their ability to recognize and manage lithium toxicity as well as their comfort level with the lithium-poisoned patient. After the simulation, residents reported an increased comfort level with managing lithium-poisoned patients. Residents also self-reported an increased ability to recognize the signs and symptoms of lithium toxicity. Additionally, residents cited the case's educational importance and a desire to include this specific scenario in future simulation sessions. Compared to other disease processes, toxicological overdoses are infrequently seen in the emergency department. Health care simulation can effectively portray lithium toxicity for emergency medicine resident education in a safe, controlled environment to increase repetitive practice in caring for this challenging population.

A consensus list of ultrasound competencies for graduating emergency medicine residents.

Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method. We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional expert panel including 15 faculty members from diverse practice environments and geographical regions. The panel voted on the list of competencies through two rounds of a modified Delphi process using a modified Likert scale (1=not at all important, 5=very important) to determine levels of agreement for each application-with revisions occurring between the two rounds. High agreement for consensus was set at >80%. Fifteen of 15 panelists completed the first-round survey (100%) that included 359 topics related to EUS. After the first round, 195 applications achieved high agreement, four applications achieved medium agreement, and 164 applications achieved low agreement. After the discussion, we removed three questions and added 13 questions. Fifteen of 15 panelists completed the second round of the survey (100%) with 209 of the 369 applications achieving consensus. Our final list represents expert opinion on EUS competencies for graduating EM residents. We hope to use this consensus list to implement a more consistent EUS curriculum for graduating EM residents and to standardize EUS training across EM residency programs.

A Novel Ocular Tonometry Task Trainer.

The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry. We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice. The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}). We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.

A Porcine-Based Task Trainer for the Instruction of Seidel's Test and Ocular Foreign Body Removal.

Ophthalmologic emergencies account for tens of thousands of patients presenting to the emergency department (ED) each year. Studies continue to show that ophthalmology education in medical school is limited, and this leads to many resident physicians who lack confidence in their ophthalmological examination and procedural skills if opportunities to practice these skills are not deliberately sought out during their training. Medical simulation continues to be an excellent way for physicians to learn and master these anxiety-inducing procedures. We present a newly modified, innovative, and realistic porcine-based emergency ophthalmologic procedural task trainer with live television screen projection to further improve Emergency Medicine (EM) resident education on the performance of Seidel's test and ocular foreign body removal.

285 Care for the Detainee in the Emergency Department Utilizing Simulation

Incarcerated patients represent a vulnerable population known to have an elevated burden of chronic disease and lower socioeconomic status. Mass incarceration in the United States leads to 10.9 million people passing through its jails, 6.7 million under correctional supervision, and 650,000 people returning to the community each year. The legal right to health care for incarcerated patients was established in 1976 but equitable and empathetic treatment by clinicians demands greater attention. Emergency medicine resident education has a persistent and notable gap in understanding health care for persons impacted by incarceration.

Pilot Study for Assessing Nontechnical Skills in Emergency Medicine Residents: Why We Should C.A.R.E.

Background: The growing regulatory and hospital focus on patient experience and patient satisfaction is evidenced by the Centers for Medicare and Medicaid Services implementation of Hospital Value-Based Purchasing and by the Accreditation Council for Graduate Medical Education milestones. However, there is a paucity of data examining the education and evaluation of emergency medicine residents’ nontechnical skills (eg, communication and situational awareness) as they relate to patient interactions. The purpose of the current study was to evaluate a nontechnical skills rating tool with emergency medicine residents during their interactions with patients.Methods: As part of the educational initiative, the authors consulted with a hospitality training and measurement company, the Freeman Group, that developed and trained faculty on the use of an observational tool to assess physicians’ nontechnical skills. Nontechnical skills were assessed in 4 domains designated by the acronym C.A.R.E.: connect with the patient, adjust the interaction to meet patient needs, resolve patient requests, and empathize with the patient. Faculty observed emergency medicine residents as they interacted clinically with patients in the emergency department and rated them on a binary scale: acceptable or unacceptable.Results: Thirty-four of 36 residents were observed. Our study demonstrates that the residents performed very well on domains of empathy, adjusting to patients’ knowledge, and resolving requests. However, residents’ abilities to customize conversations to patients (eg, addressing patients appropriately and establishing and maintaining rapport) were rated as unacceptable 31% of the time.Conclusion: Overall, residents performed well on most aspects of nontechnical skills observed during their interactions with patients. However, even when residents were mindful of faculty observing nontechnical skills, they performed unacceptably in their communication with patients in approximately one-third of the interactions. This study provides important insight into nontechnical skill areas that may be influenced with intervention to improve patient interactions, and ultimately, influence patient satisfaction.