Pediatric Emergency Medicine Fellowship Research Articles

Determining content for a simulation-based curriculum in pediatric emergency medicine: results from a national Delphi process.

By the end of residency training, pediatric emergency medicine (PEM) residents are expected to have developed the confidence and abilities required to manage acutely ill children. Acquisition of competence requires exposure and/or supplemental formal education for critical and noncritical medical clinical presentations. Simulation can provide experiential learning and can improve trainees' knowledge, skills, and attitudes. The primary objective of this project was to identify the content for a simulation-based national curriculum for PEM training. We recruited participants for the Delphi study by contacting current PEM program directors and immediate past program directors as well as simulation experts at all of the Canadian PEM fellowship sites. We determined the appropriate core content for the Delphi study by combining the PEM core content requirements of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the American Board of Pediatrics (ABP). Using the Delphi method, we achieved consensus amongst the national group of PEM and simulation experts. The participants completed a three-round Delphi (using a four-point Likert scale). Response rates for the Delphi were 85% for the first round and 77% for second and third rounds. From the initial 224 topics, 53 were eliminated (scored <2). Eighty-five topics scored between 2 and 3, and 87 scored between 3 and 4. The 48 topics, which were scored between 3.5 and 4.0, were labeled as "key curriculum topics." We have iteratively identified a consensus for the content of a national simulation-based curriculum.

Introducing Teamwork Challenges in Simulation Using Game Cards.

Poor teamwork and communication during resuscitations are linked to patient safety problems and poorer outcomes. We present a novel simulation-based educational intervention using game cards to introduce challenges in teamwork. This intervention uses sets of game cards that designate roles, limitations, or communication challenges designed to introduce common communication or teamwork problems. Game cards are designed to be applicable for any simulation-based scenario and are independent from patient physiology. In our example, participants were pediatric emergency medicine fellows undergoing simulation training for orientation. We describe the use of card sets in different scenarios with increasing teamwork challenge and difficulty. Both postscenario and summative debriefings were facilitated to allow participants to reflect on their performance and discover ways to apply their strategies to real resuscitations. In this article, we present our experience with the novel use of game cards to modify simulation scenarios to improve communication and teamwork skills.

Point-of-care Ultrasonography by Pediatric Emergency Medicine Physicians.

In 2001 the American College of Emergency Physicians (ACEP) first published specialty-specific guidelines for point-of-care ultrasound (US) in emergency medicine (EM). At the same time, the Accreditation Council for Graduate Medical Education mandated that EM residents graduate with competency in point-of-care US. The guidelines and call for competency have since gained broad professional society acceptance.1-6 Several of the point-of-care US applications described in the ACEP guidelines and in the EM literature are not necessarily relevant to the practice of pediatric EM (PEM). In addition, there are applications that have not been well delineated in EM and are applicable to PEM practitioners. To date, the majority of PEM physicians have completed pediatrics residencies without point-of-care US training. In addition, point-of-care US only recently became a core competency for PEM fellowship training.7 Consequently, PEM as a specialty has been slower to adopt and incorporate point-of-care US into clinical practice. Over the past several years, point-of-care US has gained acceptance by PEM providers. There is a dedicated PEM point-of-care textbook,8 PEM fellowship training guidelines,7 and an organization devoted to PEM point-of-care US providers (www.P2network.com). Moreover, PEM physician use of point-of-care US has increased dramatically. Specifically, 95% of emergency departments with a PEM fellowship program incorporate point-of-care US into patient care, and 88% provide training for PEM fellows.9 The demand for training is increasing, and as of 2015 there are 12 PEM-specific US fellowships.10 This month, the American Academy of Pediatrics (AAP) published the first guideline for point-of-care US use by PEM physicians. The AAP policy statement11 and accompanying technical report12 provide background and a framework for PEM physicians, who currently use or are planning to incorporate point-of-care US into their practice. The documents represent a joint effort by the AAP, the Society for Academic Emergency Medicine, ACEP, and the World Interactive Network Focused on Critical Ultrasound.

Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency medicine (PEM) physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. PEM fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for PEM physicians.

Pediatric emergency medicine fellowship programs.

Pediatric Emergency Care: April 2015 - Volume 31 - Issue 4 - p 308-314 doi: 10.1097/PEC.0000000000000431

The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency.

Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians. We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability. The TACTIC demonstrated good interrater reliability with an r 2 =0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54-76 v. postcourse TACTIC=84%, 95% CI 80-88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%. The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner's skill inserting chest tubes in a simulated setting.

Altered Mental Status in a Toddler

Abstract Introduction There are many causes of mental status changes in a 2-year-old. To help pediatric emergency medicine fellows identify some of the more rare causes, we created this simulated c...

A Novel Approach to Combining Pediatric Emergency Medicine and Global Health Fellowships.

To describe the creation of the first known combined Pediatric Emergency Medicine-Global Health (PEM-GH) fellowship for graduates of pediatric or emergency medicine residency programs. We detail the necessary infrastructure for a successfully combined PEM-GH fellowship including goals, objectives, curriculum, timeline, and funding. The fellowship is jointly supported by the department of pediatrics, section of pediatric emergency medicine (PEM), and the hospital. Fellows complete all requirements for the PEM fellowship and Global Health, the latter requiring an additional 12 months of training. Components of the Global Health fellowship include international fieldwork, scholarly activity abroad, advanced degree coursework, disaster training, and didactic curricula. Since 2005, 9 fellows (8 pediatric-trained and 1 emergency medicine-trained) have completed or are enrolled in the PEM-GH fellowship; 3 have graduated. All fellows have completed or are working toward advanced degrees and have or will participate in the disaster management course. Fellows have had 7 presentations at national or international meetings and have published 6 articles in peer-reviewed journals. Of the three graduates, all are working in academic PEM-GH programs and work internationally in Africa and/or Latin America. Our response to a global trend toward improvement in PEM care was the development of the first combined PEM-GH fellowship program. Recognizing the value of this program within our own institution, we now offer it as a model for building such programs in the future. This fellowship program promises to be a paradigm that can be used nationally and internationally, and it establishes a foundation for a full-fledged accredited and certified subspecialty.

Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion

OPEN ACCESSSeptember 26, 2014Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion Jennifer Mitzman, MD, Mary Wittler, MD Jennifer Mitzman, MD Wake Forest School of Medicine of Wake Forest Baptist Medical Center Google Scholar More articles by this author , Mary Wittler, MD Wake Forest School of Medicine of Wake Forest Baptist Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9893 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This educational resource provides information and materials for a simulation case suitable for resident physicians in emergency medicine. The scenario has been used at our institution for the past year. Participants have included medical students, emergency medicine and general pediatrics residents in years 1-3 of postgraduate education, and pediatric emergency medicine fellows in years 4-6 of postgraduate education. Methods: This simulation involves a patient presenting to an emergency department with an anion gap metabolic acidosis secondary to acute salicylate ingestion. Evaluation in the emergency department reveals a tachycardic, tachypneic patient who requires aggressive fluid resuscitation. The patient also requires alkalinization with bicarbonate to halt the progression of the acidosis. Ultimately, levels obtained should prompt learners to admit the patient to the intensive care unit for dialysis. The case has been used with small groups of two to four learners in each session. Debriefing materials are provided to illustrate key concepts in recognition of anion gap metabolic acidosis and to stimulate discussion of the important treatment steps in acute salicylate ingestion. Typical timing for the case is approximately 20 minutes for the simulation and 20 minutes for debriefing. Results: Testing of this scenario has been accomplished via repetition with various learners. While this educational case has been used for simulation sessions as part of the didactic component of our residency and fellowship, it has not been validated as a formal assessments tool for evaluation of clinical competency. Discussion: Implementation of this case requires significant resources: a high-fidelity patient simulator, appropriate environment, medical equipment, and personnel to provide the educational experience for learners. The case requires one faculty or staff member capable of running the simulator and one faculty member with the required clinical expertise to facilitate the case and conduct the debriefing and educational session. We have used this case primarily for resident physician education in pediatrics and emergency medicine, as well as for fellows in pediatric emergency medicine. Medical students have participated at times in supporting provider roles but not as team leaders given the degree of difficulty of this case. Educational Objectives By the end of this simulation, learners will be able to: Demonstrate recognition of acute salicylate toxicity.Identify the need for fluid resuscitation.Interpret arterial blood gas and recognize acid-base disturbance.Understand the need to begin alkalinization and initiate bicarbonate. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide Aspirin Case.docx Simulation Template Acute Salicylate Ingestion.docx Appendix A Aspirin Case Labs and Imaging.ppt Appendix B Aspirin Debriefing Tool.pptx Appendix C Aspirin Case Evaluation Form.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMitzman J, Wittler M. Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion. MedEdPORTAL. 2014;10:9893. https://doi.org/10.15766/mep_2374-8265.9893 Copyright & Permissions© 2014 Mitzman and Wittler. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEatingAcute PoisoningEditor's ChoiceSalicylatesIngestion Disclosures None to report. Funding/Support None to report. Loading ...

National Survey of Pediatric Emergency Medicine Fellows on Debriefing After Medical Resuscitations.

Medical resuscitations of critically ill children in the emergency department are stressful events requiring a coordinated team effort. Current guidelines recommend debriefing after such events to improve future performance. Debriefing practices within pediatric emergency departments by pediatric emergency medicine (PEM) fellows in the United States has not been studied. The aim of this study was to describe the current debriefing experience of PEM fellows in the United States. A 10-item, anonymous questionnaire regarding debriefing characteristics was distributed to fellows in US Accreditation Council for Graduate Medical Education-accredited PEM programs via e-mail and paper format from December 2011 to March 2012. Results were summarized using descriptive statistics. Of 393 eligible PEM fellows, 201 (51.1%) completed the survey. The 201 respondents included 82 first-year fellows (40.8%), 71 second-year fellows (35.3%), and 48 third-year fellows (23.9%). Ninety-nine percent had participated in medical resuscitations during their fellowship training, yet 88.0% reported no formal teaching on how to debrief. There was wide variability in the format and timing of debriefings. The majority of debriefings were led by PEM attending physicians (65.5%) and PEM fellows (19.6%). Most (91.5%) of the fellows indicated they would like further education about debriefing. The majority of PEM fellows do not receive formal training on how to debrief after a critical event and may have limited experience in leading debriefings. Debriefing training should be considered part of the educational curriculum during PEM fellowship.

Effects of a web-based educational module on pediatric emergency medicine physicians' knowledge, attitudes, and behaviors regarding youth violence.

Introduction:Youth seen in the emergency department (ED) with injuries from youth violence (YV) have increased risk for future violent injury and death. Pediatric emergency medicine (PEM) physicians rarely receive training in, or perform, YV screening and intervention. Our objective was to examine effects of a web-based educational module on PEM physicians' knowledge, attitudes, and behaviors regarding YV screening and interventions in the ED.Methods:We invited all PEM fellows and attendings at an urban Level I pediatric trauma center to complete an interactive web-based education module (and 1-month booster) with information on YV's public health impact and how to screen, counsel and refer YV-involved patients. Consenting subjects completed electronic assessments of YV prevention knowledge and attitudes (using validated measures when possible) before and after the initial module and after the booster. To measure behavior change, chart review identified use of YV-specific discharge instructions in visits by YV-injured PEM patients (age 12–17; identified by E codes) 6 months before and after the intervention. We analyzed survey data were analyzed with Fisher's exact for binary outcomes and Kruskal-Wallis for Likert responses. Proportion of patients given YV discharge instructions before and after the intervention was compared using chi-square.Results:Eighteen (67%) of 27 PEM physicians participated; 1 was lost at post-module assessment and 5 at 1 month. Module completion time ranged from 15–30 minutes. At baseline, 50% of subjects could identify victims' re-injury rate; 28% were aware of ED YV discharge instructions. After the initial module and at 1 month, there were significant increases in knowledge (p<0.001) and level of confidence speaking with patients about avoiding YV (p=0.01, df=2). Almost all (94%) said the module would change future management. In pre-intervention visits, 1.6% of patients with YV injuries were discharged with YV instructions, versus 15.7% in the post-intervention period (p=0.006, 95%CI for difference 3.6%-24.5%).Conclusion:A brief web-based module influenced PEM physicians' knowledge and attitudes about YV prevention and may have affected behavior changes related to caring for YV victims in the ED. Further research should investigate web-based educational strategies to improve care of YV victims in a larger population of PEM physicians.

Patient safety training in pediatric emergency medicine: a national survey of program directors.

The Accreditation Council for Graduate Medical Education requires training in patient safety and medical errors but does not provide specification for content or methods. Pediatric emergency medicine (EM) fellowship directors were surveyed to characterize current training of pediatric EM fellows in patient safety and to determine the need for additional training. From June 2013 to August 2013, pediatric EM fellowship directors were surveyed via e-mail. Of the 71 eligible survey respondents, 57 (80.3%) completed surveys. A formal curriculum was present in 24.6% of programs, with a median of 6 hours (range = 1 to 18 hours) dedicated to the curriculum. One program evaluated the efficacy of the curriculum. Nearly 91% of respondents without formal programs identified lack of local faculty expertise or interest as the primary barrier to implementing patient safety curricula. Of programs without formal curricula, 93.6% included at least one component of patient safety training in their fellowship programs. The majority of respondents would implement a standardized patient safety curriculum for pediatric EM if one was available. Despite the importance of patient safety training and requirements to train pediatric EM fellows in patient safety and medical errors, there is a lack of formal curriculum and local faculty expertise. The majority of programs have introduced components of patient safety training and desire a standardized curriculum.

Surgeon as Educator: Bedside Ultrasound in Hypertrophic Pyloric Stenosis

Our institution has demonstrated the diagnostic accuracy of surgeon-performed ultrasound (US) in the diagnosis of hypertrophic pyloric stenosis (HPS). Moreover, we have also shown this modality to be accurate and reproducible through surgeon-to-surgeon instruction. The purpose of this study was to determine whether a surgical resident with experience in diagnosing HPS can teach pediatric emergency medicine (PEM) fellows, with little experience in sonography, to accurately measure the pyloric channel with bedside US. A surgical resident with experience in diagnosing HPS with US-proctored 4 emergency medicine fellows for 5 bedside US examinations each. A PEM fellow, who was blinded to the results from the radiology department US, then performed bedside US and measured the pyloric channel in patients presenting to the emergency department with HPS. Results between the radiology department and the fellows were compared using the Student t test. In total, 18 USs were performed on 17 patients. There were no false-negative or false-positive results. There was no statistical difference between the radiology department and fellow measurement when evaluating muscle width (p = 0.21, mean deviation = 0.2 mm) or channel length (p = 0.47, mean deviation = 0.6 mm). Bedside-performed US technique for measuring the pylorus length and width in patients with HPS is reproducible and accurate when taught to PEM providers. The learning curve for this technique is short.

191: Pediatric Pain Management: the Emergency Medicine Residents' Perspectives

Pain is a component of up to 80% of all emergency department (ED) visits. Oligoanalgesia, the under-treatment of pain, is a recognized problem in the ED and can have numerous detrimental effects for the pediatric patient. Surveying emergency medicine residents, our primary objectives were to describe a) the extent and type of training received in pediatric acute pain management, b) their management approach to common painful pediatric presentations, c) their level of comfort in assessing and treating acute pain, d) their perceived facilitators and barriers to optimally managing pain, and e) their attitudes towards managing such pain in the ED. A descriptive, cross-sectional survey was administered to all Royal College Emergency Medicine (EM) and Pediatric Emergency Medicine (PEM) residents, the Canadian College of Family Physician's EM residents, Clinical Fellows and PEM Fellows at three Canadian universities. A novel survey tool was created and distributed from May to June 2013. Surveys were completed online, using a modified Dillman approach. Our response rate was 46% (56 of 122). Forty-five percent (25 of 55) of residents had not received any training for pediatric pain assessment. All years of residents were uncomfortable with the assessment of pain in 0- to 2-year-olds (P=0.07). For patients aged two to 12 years, level of comfort with pain assessment increased with years of training (P=0.02). When assessing pain in children with disabilities, 83% (45 of 54) of residents were ‘extremely’ or ‘somewhat’ uncomfortable; 65% (47 of 55) of residents had not received any training on how to assess pain for such patients. Sixty-nine percent (38 of 55) of residents had received training on how to treat pediatric pain. All residents were more comfortable using pain medication for a nine-year-old, as compared to a one-year-old (oral oxycodone P=0.00003, oral morphine P=0.00002, IV morphine P=0.004). Ninety-eight percent (54 of 55) of residents felt that it was ‘extremely’ or ‘somewhat’ important to receive education about pediatric pain management. Their preferred methods to learn children's pain management were through role modeling (61%) and lectures (57%). Top challenges to optimal pediatric pain management were non-verbal patients, patients with disabilities, and young infants. Pediatric pain management education is important to EM residents. Residents recall receiving sub-optimal training on this important topic. They are especially uneasy in the management of younger children and those with disabilities. This study's findings can be used to inform post-graduate curriculum planning, in order to optimize pediatric pain assessment and treatment education.

A Module-Based Pediatric ECG Curriculum to Improving Accuracy of ECG Interpretation by Pediatric Emergency Medicine Providers

OPEN ACCESSApril 24, 2014A Module-Based Pediatric ECG Curriculum to Improving Accuracy of ECG Interpretation by Pediatric Emergency Medicine Providers Priya Gopwani, MD, Shilpa Patel, E. Anne Greene, Jennifer Chapman Priya Gopwani, MD Children's National Medical Center Google Scholar More articles by this author , Shilpa Patel Children's National Medical Center Google Scholar More articles by this author , E. Anne Greene Children's National Medical Center Google Scholar More articles by this author , Jennifer Chapman Children's National Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9779 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Electrocardiograms (ECGs) are ordered frequently in the pediatric emergency department (ED). The majority of these ECGs are interpreted initially by pediatric emergency medicine (PEM) physicians, with a cardiologist reinterpreting the ECG after patient disposition has been made. Previous studies have shown that neither emergency medicine nor pediatric residency training programs adequately train residents to read ECGs. We designed a web-based pediatric ECG curriculum aimed specifically at fellow and attending PEM providers. The overall goal of this curriculum is to improve the “first read” accuracy of ECG interpretation and decrease the number of missed diagnoses. Methods: The curriculum consists of seven web-based modules focusing on pediatric ECGs and their interpretation in the ED setting. These modules cover the basics of pediatric ECGs, long QT syndrome & brugada, supraventricular tachycardia and Wolff Parkinson White syndrome, heart block and sick sinus syndrome, ventricular tachycardia, ischemia and infarct, and congenital heart disease. The case-based modules run for 7-12 minutes and are interactive, requiring the user to recognize abnormalities and perform necessary calculations before proceeding. Results: This module was administered to PEM fellows at a large urban pediatric teaching hospital. A pretest consisting of 20 ECGs was administered to all PEM fellows and a self-selected group of PEM attendings. At the completion of the curriculum, a posttest was administered to assess improvement. The average accuracy of identifying the ECG abnormality at pretest was 42.8% (PEM Fellows M = 40.6%, N = 9; PEM Attendings M = 45.7% N = 7). All nine fellows completed the posttest. There was a statistically significant improvement in the PEM fellows' ability to accurately interpret ECG findings using these modules were used (42.0% v 53.1%, p = .047, Wilcoxon Signed-Rank test). On an accompanying satisfaction survey, 100% would recommend the curriculum to a colleague and 76.5% thought the ECG modules could stand alone in teaching ECG interpretation to PEM providers. Discussion: There is a need to improve the ability of PEM physicians to read ECGs, particularly those with clinically significant findings. We designed a web-based pediatric ECG curriculum aimed specifically at PEM providers with the overall goal of improving the “first read” accuracy of ECG interpretation and to decrease the number of missed diagnoses. Based on learner feedback, we determined that the implementation of a combined module-based and didactic pediatric ECG curriculum improved the ability of PEM fellows to accurately interpret ECGs with abnormalities. Educational Objectives By the end of this session, learners will be able to: Demonstrate a systematic approach to reading pediatric ECGs.Describe clinically significant findings on pediatric ECGs.Formulate the initial treatment plan for pediatric patients with clinically significant findings on ECGs. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: MedEdPORTAL Instructors Guide.docx ECG Basics.mp4 LQTS Brugada.swf SVT and WPW.swf HB and SSS.swf VT.swf Ischemia Infarct.swf Congenital Heart Disease.swf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Gopwani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsPediatricsElectrocardiographyPediatric Emergency MedicineElectrocardiogramsECGs Disclosures None to report. Funding/Support None to report. Loading ...

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Medicine Fellowship Programs

Accuracy of Laceration Length Estimation in a Pediatric Emergency Department and Its Impact on Billing Practices

This study aimed to determine the accuracy of laceration length estimation in a pediatric emergency department among health care providers of varying levels of training and its impact on billing practices. This study involves a prospective case series. Children younger than 21 years with lacerations evaluated and repaired in the pediatric emergency department between January 1 and April 30, 2012, were eligible for enrollment. Each laceration was evaluated by a trainee/midlevel provider (frontline provider) and by an attending physician; each one offered an estimated laceration length. The true measurement was then documented by 1 of 6 pediatric emergency medicine fellows on shift. Data were analyzed using descriptive statistics. The mean error of estimation (the absolute differences between the estimated and the true laceration length) of attending physicians and frontline providers were determined and compared. The proportions of lacerations whose estimated length was in a different billing category were compared using χ(2). Cost analysis was documented. One hundred ninety patients were enrolled. The mean age was 5.9 years. A total of 119 patients (62.6%) were male, and 134 lacerations (70.5%) were located on the face. Most repairs were simple (79%). There was no difference between the estimated and measured length among attendings and frontline providers (P = 0.583). An average of 8.2% of lacerations were misclassified and billed incorrectly with 20% (4/20) of facial lacerations up-coded. The mean overcharge was $12.04. Of 11 lacerations elsewhere on the body, 3 (27%) were down-coded, with an average difference of $6.97 for simple and $38.51 for layered repairs. Pediatric emergency medicine practitioners are accurate estimators of laceration length. Eight percent of lacerations are misclassified and billed incorrectly. Physicians should be required to report measured lengths for billing.

The Making Evidence-Based Medicine Simple Series — Therapy Module

OPEN ACCESSJuly 15, 2013The Making Evidence-Based Medicine Simple Series — Therapy Module Michael Mojica, MD Michael Mojica, MD New York University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9478 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The Making Evidence Based Medicine Simple Series is an evidence-based clinical practice curriculum. It consists of six modules that review the articles types addressing the most common clinical questions (i.e., diagnosis, therapy, harm, prognosis, meta-analysis, and clinical decision rules). Each module reviews an article from the medical literature using the Users Guide to Medical Literature criteria for validity, results, and applicability. Each modules includes a PowerPoint presentation with a script, a video of the presentation with narration, a quiz with answers, tips for teaching the module, a blank review form, and a completed critical article review for the article reviewed in the module. Methods: The Therapy Module reviews the appraisal of the validity, results, and applicability of a randomized clinical trial of steroid therapy for mild croup. The study addresses the following clinical question: In children with mild croup in the emergency department, will oral dexamethasone when compared to placebo result in a reduction in unscheduled return visits? In addition, this module reviews the following critical appraisal skills: (1) differentiating between a superiority, non-inferiority, and equivalence analysis, (2) identifying the role of randomization, allocation concealment, and blinding in reducing bias, (3) distinguishing between an intention to treat and per protocol analysis, (4) calculating absolute risk, absolute risk reduction, and relative risk from a 2 × 2 table, (5) distinguishing between clinical and statistical significance, and (6) calculating/interpreting a number needed to treat. Results: Evaluations by course participants have been extremely positive. Participants often comment that they have finally grasped important content that they have previously struggled with. The materials have been particularly useful to those who are leading a teaching session. Feedback from a 2013 course for pediatric emergency medicine fellows indicated that 92% of participants felt the Therapy Module was “extremely helpful.” In addition, 100% of participants agreed or strongly agreed that the modules improved their ability to appraise an article, and their ability to conduct evidence-based clinical practice. One-hundred percent also agreed or strongly agreed that the precourse materials were useful. Discussion: The Making Evidence Based Medicine Simple Series is a well-received evidence based clinical practice curriculum and the Therapy Module is an effective component of the series that can be used independently or with the other modules. Educational Objectives By the end of this session, learners will be able to: Evaluate the validity, results, and applicability of a therapy article.Develop a “clinical bottom line” for a therapy article.Describe the steps in a randomized controlled trial.Differentiate analysis types (i.e., superiority, non-inferiority, and equivalence studies).Outline a therapy question in population/patient, intervention/indicator, comparator/control, and outcome format.Understand the validity criteria for a therapy study.Define randomization, allocation concealment, and blinding.Identify the effects of randomization, allocation concealment, and blinding on bias.Distinguish between an intention to treat and per protocol analysis.Calculate absolute risk, absolute risk reduction, and relative risk from a 2 × 2 table.Calculate relative risk reduction and understand its limitation.Distinguish between clinical and statistical significance.Interpret statistical significance from a confidence interval of an absolute risk reduction and relative risk.Understand the applicability criteria for a therapy study.Calculate and interpret a number needed to treat and number needed to harm.Create a clinical bottom line for a therapy study. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Critical Appraisal Form - Therapy - Blank.doc Critical Appraisal From - Dexamethasone for Mild Croup.pdf EBM Teaching Tips - General Approach to the Modules.pdf EBM Teaching Tips - Therapy.pdf Instructor's Guide - MESS Curriculum - Overview.pdf Instructor's Guide - MESS Curriculum - Therapy Module.pdf Lecture Notes - Therapy.pdf Lecture Slides - Therapy.pdf Lecture Slides - Therapy.ppt QUIZ ANSWERS Therapy.pdf QUIZ Therapy.pdf Video Screencast - Therapy.mp4 To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related The Making Evidence-Based Medicine Simple Series — Diagnostic Testing Module The Making Evidence-Based Medicine Simple Series — Therapy Module The Making Evidence-Based Medicine Simple Series — Harm Module The Making Evidence-Based Medicine Simple Series — Prognosis Module The Making Evidence-Based Medicine Simple Series — Meta-analysis Module The Making Evidence-Based Medicine Simple Series - Clinical Decision Rule Module Copyright & Permissions© 2013 Mojica. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsEvidence-Based Clinical PracticeMeta-AnalysisJournal ClubDiagnostic TestingClinical Prediction RuleHarmPrognosisClinical Decision RuleTherapyEvidence-Based Medicine Disclosures None to report. Funding/Support None to report. Loading ...

The Making Evidence-Based Medicine Simple Series — Diagnostic Testing Module

Abstract Introduction The Making Evidence Based Medicine Simple Series is an evidence-based clinical practice curriculum. It consists of six modules that review the articles types addressing the mo...

Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents

Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a paired t-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%, p < 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.