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

CJEM ◽  
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.

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

CJEM ◽  
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.

scholarly journals Clinical teaching in a busy emergency department: strategies for success

CJEM ◽  
2002 ◽  
Vol 4 (04) ◽  
pp. 286-288 ◽  
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.

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

2016 ◽  
Vol 21 (03) ◽  
pp. 388-394 ◽  
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.

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

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S91-S92
Author(s):  
S. Crawford ◽  
G. McInnes ◽  
S. Jarvis-Selinger ◽  
D.R. Harris
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Medical Students ◽  
Professional Education ◽  
Educational Innovation ◽  
Secondary Outcome ◽  
Qualitative Feedback ◽  
Quantitative Score ◽  
Narrative Response ◽  
Health Canada

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.

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

CJEM ◽  
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.

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Tourist Experience and Innovative Hospitality Management in Different Cities

2021 ◽  
Vol 13 (12) ◽  
pp. 6578
Author(s):  
Alon Gelbman
Keyword(s):  
Qualitative Methodology ◽  
Participant Observation ◽  
Hospitality Management ◽  
Tourist Experience ◽  
Hospitality Organizations ◽  
Culture Characteristics ◽  
Tourism And Hospitality ◽  
Document Review ◽  
Creativity And Innovation

The complexity of modern tourism and hospitality management because of competition in the destination market, and especially in urban tourism destinations, has created a demand for creativity and innovation. To satisfy heightened tourist expectations for a specialized experience, hospitality organizations emphasize local culture characteristics and the urban community. The purpose of this paper is to examine how an urban hospitality organization emphasizes community and social values in its hostels, and how the tourist experience is adapted to each city’s culture and atmosphere (Nazareth, Jerusalem, and Tel Aviv). The theoretical framework is based on the link connecting urban hospitality with the tourist experience, and how tourism innovation and creativity is managed, during this age of competition and specialization. The qualitative methodology includes participant observation, document review, and in-depth interviews. The findings of this study add a new dimension to the existing knowledge, namely the role of creativity and innovation in helping the management of an urban hospitality organization to shape the tourist experience. The study developed a new unique model for “implementing innovation in urban hospitality management” which describes the framework of connections and interactions between the various sustainable community based and social aspects. The novelty of this research model lies in the emphasis on how management uses innovation and creativity to brand the whole chain so as to realize the vision and values it wishes to promote. This also entails a system of sub-positioning that aligns the vision and values with the distinctive culture of each city and with each local community’s nature and traditions.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

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