P041: The nursing shift: measuring the effect of inter-professional education on medical students in the emergency department

Introduction/Innovation Concept: Inter-professional education (IPE) involves ‘occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care’. Current literature has found IPE to increase knowledge and skills, improve attitudes towards other professions, and to promote superior clinical outcomes. Health Canada has collaborated to form accreditation standards to support IPE in Canadian medical schools. The proposed educational innovation termed the ‘nursing shift,’ based out of Kelowna General Hospital’s Department of Emergency Medicine, in partnership with UBC’s Southern and Island Medical Programs, endeavors to enhance IPE in our institution. Methods: This nursing shift was first trialed with third year medical students as a pilot rotation beginning in March of 2016. Based on overwhelmingly positive results obtained from narrative feedback, a formal rotation with the same structure will be implemented in the form of a prospective cohort study with 48 medical students from two UBC sites. One group will attend a nursing shift, while the other group will complete the standard emergency medicine rotation without this nursing shift. Impact will be measured using a mixed-method analysis where students will be asked to provide both quantitative feedback in the form of a questionnaire, and qualitative feedback in the form of a narrative response. The primary outcome will be quantitative score differences between the groups of students, and the secondary outcome will be qualitative results for those who completed the nursing shift. Curriculum, Tool, or Material: The innovative educational concept consists of an 8-hour nursing shift where medical students spend the first 4 hours at triage with a nurse learning about patient intake. The remaining 4 hours are in the emergency department where students collaborate with a nurse on a number of tasks including preparing and administering medications, starting intravenous lines, and inserting Foley catheters. Conclusion: Healthcare systems are shifting to a more collaborative team oriented approach, and IPE has been shown to prepare students for this changing workplace. We seek to understand third year medical students’ experience of the nursing shift, and to evaluate any changes in attitudes towards inter-professional collaboration after engaging in this intervention. Evaluation of this novel implementation will enable us to assess and optimize the nursing shift, and if it is well received, encourage widespread adoption.

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MP19: Identifying and transmitting the culture of emergency medicine through simulation

CJEM ◽

10.1017/cem.2020.167 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S49-S49

Author(s):

E. Purdy ◽

C. Alexander ◽

M. Caughley ◽

S. Bassett ◽

V. Brazil

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Medical Students ◽

Participant Observation ◽

Core Values ◽

Recursive Method ◽

Beliefs And Practices ◽

Inductive Approach ◽

Review Analysis ◽

Document Review

Introduction: Simulation is commonly used in medical education. It offers the opportunity for participants to apply theoretical knowledge and practice non-technical skills. We aimed to examine how simulation may also help to identify emergency medicine culture and serve as a tool to transmit values, beliefs and practices to medical learners. Methods: We undertook a focused ethnography of a simulated emergency department exercise delivered to 98 third-year medical students. This ethnography included participant-observation, informal interviews, and document review. Analysis was performed using a recursive method, a simultaneous deductive and inductive approach to data interpretation.We undertook a focused ethnography of a simulated emergency department exercise delivered to 98 third-year medical students. This ethnography included participant-observation, informal interviews, and document review. Analysis was performed using a recursive method, a simultaneous deductive and inductive approach to data interpretation. Results: All 20 staff (100%) and 92 of 98 medical students (94%) participated in the study. We identified 7 core values – identifying and treating dangerous pathology, managing uncertainty, patients and families at the center of care, balancing needs and resources at the system level, value of the team approach, education as integral, and emergency medicine as part of self-identity – and 27 related beliefs that characterized emergency medicine culture. We observed that culture was transmitted during the simulation exercise. Conclusion: This study contributes to the characterization of the culture of emergency medicine by identifying core values and beliefs that are foundational to the specialty. Simulation facilitated cultural compression which allowed for ready identification of values, beliefs and practices and also facilitated transmission of culture to learners. This study expands understanding of the culture of emergency medicine and the role of simulation in the process of cultural exchange.

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Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2018-000398 ◽

2018 ◽

Vol 6 (1) ◽

pp. 10-14

Author(s):

Katherine Couturier ◽

Travis Whitfill ◽

Ambika Bhatnagar ◽

Rajavee A Panchal ◽

John Parker ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Randomised Trial ◽

Neonatal Resuscitation ◽

Secondary Outcome ◽

Care Group ◽

Control Group ◽

Task Load ◽

Significant Difference ◽

Nasa Tlx

BackgroundThe delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes.IntroductionTelemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access.Materials and methodsProspective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants’ completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist.ResultsTwelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001).ConclusionsIn this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.

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LO11: STAR-EM: An innovative summer research program for medical students in an urban Canadian academic emergency department

CJEM ◽

10.1017/cem.2020.67 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S10-S11

Author(s):

S. Friedman ◽

D. Porplycia ◽

J. Lexchin ◽

K. Hayman ◽

S. Masood ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Program Evaluation ◽

Medical Students ◽

Research Training ◽

Project Work ◽

Manuscript Preparation ◽

Research Culture ◽

Small Group Teaching ◽

Scholarly Output

Innovation Concept: Research training programs for students, especially in emergency medicine (EM), may be difficult to initiate due to lack of protected time, resources, and mentors (Chang Y, Ramnanan CJ. Academic Medicine 2015). We developed a ten-week summer program for medical students aimed at cultivating research skills through mentorship, clinical enrichment, and immersion in EM research culture through shadowing and project support. Methods: Five second year Ontario medical students were recruited to participate in the Summer Training and Research in Emergency Medicine (STAR-EM) program at University Health Network, Toronto, from June - Aug, 2019. Program design followed review of existing summer research programs and literature regarding challenges to EM research (McRae, Perry, Brehaut et al. CJEM 2018). The program had broad emergency physician (EP) engagement, with five EP research project mentors, and over ten EPs delivering academic sessions. Curriculum development was collaborative and iterative. All projects were approved by the hospital Research Ethics Board (REB). Curriculum, Tool or Material: Each weekly academic morning comprised small group teaching (topics including research methodology, manuscript preparation, health equity, quality improvement, and wellness), followed by EP-led group progress review of each student's project. Each student spent one half day per week in the emergency department (ED), shadowing an EP and identifying patients for recruitment for ongoing mentor-initiated ED research projects. Remaining time was spent on independent student project work. Presentation to faculty and program evaluation occurred in week 10. Scholarly output included one abstract submitted for publication per student. Program evaluation by students reflected a uniform impression that course material and mentorship were each excellent (100%, n = 5). Interest in pursuing academic EM as a career was identified by all students. Faculty researchers rated the program as very effective (80%, n = 4) or somewhat effective (20%, n = 1) in terms of enhancing productivity and scholarly output. Conclusion: The STAR-EM program provides a transferable model for other academic departments seeking to foster the development of future clinician investigators and enhance ED research culture. Program challenges included delays in REB approval for student projects and engaging recalcitrant staff to participate in research.

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Clinical teaching in a busy emergency department: strategies for success

CJEM ◽

10.1017/s1481803500007545 ◽

2002 ◽

Vol 4 (04) ◽

pp. 286-288 ◽

Cited By ~ 10

Author(s):

Rick Penciner

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Medical Students ◽

Medical Practice ◽

Clinical Teaching ◽

Emergency Medical ◽

Strategies For Success

ABSTRACT Clinical teaching is an integral part of emergency medical practice. With the growing number of medical students and residents in the emergency department there are increasing expectations for clinicians to teach. But there are many challenges and obstacles to overcome when teaching in a busy department. By incorporating diverse strategies and techniques, we can become more effective and efficient emergency medicine teachers.

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You’ve Got to Hand It to Them: Assessing Final Year Medical Students Knowledge of Hand Anatomy and Pathology

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516500399 ◽

2016 ◽

Vol 21 (03) ◽

pp. 388-394 ◽

Cited By ~ 1

Author(s):

Cormac Weekes Joyce ◽

Shazrinizam Shaharan ◽

Kate Lawlor ◽

Melanie Elizabeth Burke ◽

Michael John Kerin ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

General Practice ◽

Medical Students ◽

Medical School ◽

Upper Limb ◽

Teaching Module ◽

Musculoskeletal Anatomy ◽

Practice Of Medicine ◽

Before And After

Background: Knowledge of hand anatomy and pathology is important for final year medical students as it frequently appears in examinations as a short case or in a written paper. Studies have shown that doctors in the Emergency Department have a deficient grasp of musculoskeletal anatomy secondary to a lack of dedicated teaching in medical school. Methods: A questionnaire was handed out to 111 final year medical students. Students were asked to fill it out before and after dedicated upper limb teaching sessions during their rotation. The questionnaire consisted of an anatomical and pathological component. Students were tested on basic anatomy and pathology of several common upper limb conditions. Results: There was a significant improvement in the medical students knowledge after the dedicated hand teaching. The identification of the carpal bones showed the most improvement overall. Conclusions: Basic musculoskeletal knowledge is essential to the practice of medicine. The majority of medical students gravitate towards a career in general practice or emergency medicine and good knowledge of upper limb anatomy is important. We have piloted a new interactive dedicated upper limb teaching module and have shown that there has been a significant improvement in students knowledge.

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The Utility of the Rapid Emergency Medicine Score (REMS) compared with SIRS, qSOFA and NEWS for predicting in-Hospital Mortality Among Patients with Suspicion of Sepsis in an Emergency Department

10.21203/rs.3.rs-52232/v1 ◽

2020 ◽

Author(s):

Onlak Ruangsomboon ◽

Phetsinee Boonmee ◽

Chok Limsuwat ◽

Tipa Chakorn ◽

Apichaya Monsomboon

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Hospital Mortality ◽

Early Warning ◽

Risk Model ◽

Adverse Outcomes ◽

Early Warning Score ◽

Baseline Risk ◽

Secondary Outcome ◽

Net Benefit

Abstract Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED.Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality.Results A total of 1622 patients were included in the study; 574 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p=0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p<0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p=0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality.ConclusionREMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS) and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

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P045: Human trafficking awareness, a learning module for improved recognition of victims in the emergency room

CJEM ◽

10.1017/cem.2017.247 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S93

Author(s):

J. Deutscher ◽

S. Miazga ◽

H. Goez ◽

T. Hillier ◽

H. Lai

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Medical Education ◽

Medical Students ◽

Emergency Room ◽

Human Trafficking ◽

Urgent Care ◽

Undergraduate Medical Students ◽

Learning Module ◽

Grand Rounds

Introduction/Innovation Concept: Estimates suggest that up to eighty-seven percent of human trafficking victims have come into contact with a healthcare provider during their exploitation and yet less than ten percent of emergency medicine (EM) physicians feel confident in identifying a victim. When provided with the relevant tools, medical personnel can aid in the recognition of victims and take the necessary steps in providing appropriate care when they present to the emergency department. Identifying this need for increased awareness in the urgent care setting, a module on human trafficking was implemented into the undergraduate medical education and departmental grand rounds. Methods: After identifying gaps in current medical education regarding screening for victims of human trafficking, a literature review was completed on the topic in medical education and utilized in constructing a list of objectives. These were then reviewed by community organizations that aid victims of trafficking and the Canadian Alliance of Medical Students Against Human Trafficking. Undergraduate medical students completed surveys prior to and following the learning module, in order to evaluate improvement in acquired knowledge. Curriculum, Tool, or Material: A one-hour lecture from ACT Alberta was given to undergraduate medical students as well as to residents and staff in departmental grand rounds. The session met the following objectives: defining human trafficking, recognition of victims, and identification of next steps in providing care. Additionally, an online module from Fraser Health was made available as an additional resource with case studies specific to emergency departments. The surveys consisted of 13 questions evaluating students’ knowledge on human trafficking and its prevalence in emergency medicine. The questions were a combination of a Likert scale, multiple choice, and short answer. There was a large amount of positive feedback from the students and comparison of the surveys showed that their knowledge in identifying victims had significantly improved. Conclusion: Medical students, residents, and staff may come into contact with victims of trafficking in the emergency department and yet less than three percent of emergency physicians have had training on how to recognize a victim. Implementing human trafficking awareness will impact EM medical education by providing victims a greater chance of being recognized and offered help when they present to the emergency room.

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The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department

BMC Emergency Medicine ◽

10.1186/s12873-020-00396-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Onlak Ruangsomboon ◽

Phetsinee Boonmee ◽

Chok Limsuwat ◽

Tipa Chakorn ◽

Apichaya Monsomboon

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Hospital Mortality ◽

Early Warning ◽

Risk Model ◽

Adverse Outcomes ◽

Early Warning Score ◽

Baseline Risk ◽

Secondary Outcome ◽

Net Benefit

Abstract Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED. Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality. Results A total of 1622 patients were included in the study; 457 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p = 0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p < 0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p = 0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality. Conclusion REMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS), similar to NEWS, and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

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