1343: NOVEL INTERNAL MEDICINE ULTRASOUND CURRICULUM LED BY CRITICAL CARE AND EMERGENCY MEDICINE STAFF

2020 ◽  
Vol 48 (1) ◽  
pp. 648-648
Author(s):  
Robert Geis ◽  
James Croft ◽  
Matthew Speicher ◽  
Adrianna Kyle ◽  
James Palma ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care

scholarly journals 53. A Descriptive Analysis of Air Medical Directors in the United States

1996 ◽  
Vol 11 (S2) ◽  
pp. S44-S44
Author(s):  
Kathy J. Rinnert ◽  
Ira J. Blumen ◽  
Michael Zanker ◽  
Sheryl G. A. Gabram
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Emergency Medicine ◽  
Critical Care ◽  
Descriptive Analysis ◽  
The United States ◽  
Air Transport ◽  
Medical Services ◽  
Medical Directors ◽  
Mission Profile

Purpose: The practice of helicopter emergency medical services is variable in its mission profile, crew configuration, and transport capabilities. We sought to describe the characteristics of physician air medical directors in the United States.Methods: We surveyed medical directors concerning their education, training, transport experience, and roles/responsibilities in critical care air transport programs.Results: Two page surveys were mailed to 281 air medical services. Three programs merged or were dissolved. Data from 122/278 (43.9%) air medical directors were analyzed. One-hundred eleven respondents reported residency training in: Emergency Medicine (EM) 44 (39.6%), Internal Medicine (IM) 18 (16.2%), General Surgery (GS) 18 (16.2%), Family Practice (FP) 12 (10.8%), dual-trained (EM/IM, EM/FP, IM/FP) 11 (9.9%) and others 8 (7.2%). Medical directors’ roles/responsibilities consist, most frequently of: drafting protocols 108 (88.5%), QA/CQI activities 104 (85.3%), crew training 98 (80.3%), and administrative negotiations 95 (77.7%).

scholarly journals Free Open Access Med(ical edu)cation for critical care practitioners

2017 ◽  
Vol 18 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Olusegun Olusanya ◽  
James Day ◽  
Justin Kirk-Bayley ◽  
Tamas Szakmany
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care ◽  
Open Access ◽  
Health Professionals ◽  
Online Community ◽  
Daily Basis ◽  
Allied Health Professionals ◽  
Continual Professional Development ◽  
Video Material

Free Open Access Med(ical edu)cation refers to an online community of knowledge relating to medicine. Originating from practitioners in emergency medicine, it has since spread to critical care, internal medicine, prehospital medicine, paediatrics, and allied health professionals and continues to grow at an advanced rate. Weblogs (‘blog’ for short), emails, social media (in particular Twitter), recorded audio material ((podcasts), and video material are all produced on a daily basis and contribute to the continual professional development of trainees and consultants worldwide. In this article, we explain its background, rise to prominence, and explore some of its controversies.

scholarly journals Barriers to the Effective Diagnosis and Management of a Bleeding Patient with Undiagnosed Bleeding Disorder Across Multiple Specialties: Results of a Quantitative Case-Based Survey.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3673-3673
Author(s):  
Mark T. Reding ◽  
David L. Cooper
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care ◽  
Bleeding Disorder ◽  
Initial Evaluation ◽  
Acute Bleeding ◽  
Recent Onset ◽  
Normal Plasma ◽  
Coagulation Study ◽  
Recurrent Epistaxis

Abstract Abstract 3673 Introduction: While bleeding symptoms may be commonly seen by physicians of multiple specialties, these symptoms frequently belie an underlying yet undiagnosed congenital or acquired bleeding disorder. While it represents a rare bleeding disorder (1-4 cases per 1 million population per year), acquired hemophilia (AH) is a potentially life-threatening cause of unexplained recent-onset or acute bleeding manifested by an abnormal activated partial thromboplastin time (aPTT) that does not correct with 1:1 mixing with normal plasma. Given the rarity of AH, combined with the general lack of familiarity of non-hematologists with this condition, diagnosis of AH poses a clinical challenge, even in patients presenting with a clear picture of bleeding with an isolated prolonged aPTT. Methods: Actively practicing physicians within the specialties of hematology, hematology/oncology, emergency medicine, geriatrics, internal medicine, rheumatology, obstetrics and gynecology, critical care medicine, and general surgery were randomly sampled from the American Medical Association (AMA) Physician Masterfile and completed the 10 minute online survey during January 14–28, 2010. Results: Excluding surgeons and OB/GYNs, 302 physicians (50 to 51 per specialty) had mean ages ranging from 45.6 to 49.1 years, and mean years of practice experience ranging from 14.5 to 19.1. When provided with a hypothetical case report of an elderly female patient with recurrent epistaxis, nearly 90% of physicians in each of the surveyed specialties would have ordered a complete blood count (CBC) and coagulation studies (aPTT, PT, and INR) as part of their initial evaluation. Despite the resulting aPTT being abnormal at 42 seconds, other than hematologists, less than 1/2 would have chosen to repeat the studies. Fewer than 45% of surveyed physicians in all non-hematology specialties would have consulted a hematologist, with emergency medicine physicians least likely to consult (10%), and rheumatologists most likely to consult (43%). Following the patient's second presentation several weeks later with bruising and abdominal/back pain, ≥ 90% of respondents would have ordered both a CBC and coagulation studies as part of their initial evaluation. When these results revealed a markedly changed aPTT of 63 seconds, the majority of respondents would not have repeated coagulation studies. Approximately 75% of internal medicine and geriatrics physicians would have consulted a hematologist at this point, versus 47% and 50%, respectively, in emergency medicine and critical care. Participants across specialties were clear in their preference for a CT scan of the abdomen (80%-84%). Over a hypothetically additional 12 hours of observation, 73% to 94% of respondents would have consulted a hematologist at this point in the patient's clinical presentation, with laboratory studies revealing obvious ongoing blood loss and an aPTT that was at least twice the upper limits of normal; emergency medicine physicians remained least likely to consult. The majority of hematologists would have ordered 1:1 mixing studies with normal plasma to rule out coagulation inhibitors (97%). While approximately 80% or more of physicians in each specialty would have recommended hospital admission at the second presentation, the proportion recommending admission specifically to the ICU increased as the laboratory values deteriorated (worsening anemia and coagulopathy), most noticeably for the emergency medicine gatekeepers (35% to 73%). Conclusion: Given the rarity and high morbidity and mortality of AH, physicians must harbor a high index of suspicion in order to promptly diagnose this condition in patients who present with recent-onset of acute bleeding. As exemplified by the findings of this survey, the determination of the etiology of an abnormal coagulation study should carry equal weight to looking for the site of bleeding, and could be facilitated by consultation with a hematologist. The insights from this survey highlight knowledge and practice gaps that could be the focus of targeted educational initiatives or outreach by hematologists and coagulation laboratories, including diagnostic algorithms and critical pathways to assure proper work-up of abnormal coagulation studies in patients who are not on anticoagulation. Disclosures: Reding: Novo Nordisk Inc.: Consultancy. Cooper:Novo Nordisk Inc.: Employment.

scholarly journals Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff

2021 ◽  
Author(s):  
Robert N Geis ◽  
Michael J Kavanaugh ◽  
James Palma ◽  
Matthew Speicher ◽  
Adrianna Kyle ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Internal Medicine Residency ◽  
Critical Care Medicine ◽  
Assessment Score ◽  
Medicine Resident ◽  
Hands On

ABSTRACT Introduction Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project’s aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. Materials and Methods The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents’ schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects’ research. Results Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). Conclusions A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

scholarly journals A survey demonstrating that the procedural experience of residents in internal medicine, critical care and emergency medicine is poor: training in ultrasound is required to rectify this

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mamdouh Souleymane ◽  
Rajkumar Rajendram ◽  
Naveed Mahmood ◽  
Amro M. T. Ghazi ◽  
Yousuf M. S. Kharal ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care ◽  
Improve Patient Safety ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
Procedural Skills ◽  
Skill Gaps ◽  
Residency Programme

Abstract Background Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures. Methods All IM, EM and CC residents (n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were invited to participate in a questionnaire-based survey to identify skill and experience gaps. The contribution of procedural skills to patient care (i.e. applicability) and proficiency in the sterile technique required to perform ultrasound-guided procedures were rated on Likert scales. Data on training, accreditation, and experience with and without ultrasound were collected. Results The overall response rate was 72% (IM 91%, CC 100%, EM 40%). Although the sample reported that procedural skills were very applicable, 19% (IM n = 25, EM n = 2) had not performed any procedures. However, five residents were accredited in point-of-care ultrasound, 61% of the sample had performed ultrasound-guided procedures and 65% had used landmark techniques. Whilst more internists had performed procedures using landmark techniques, CC and EM residents had performed more ultrasound-guided procedures. Whilst CC residents had not missed any opportunities to perform procedures because supervisors were less available, EM (6) and IM (89) residents had. Whilst skill gaps were only identified in the IM residency programme, experience gaps were present in all three residency programmes. The IM residency programme had larger experience gaps than the CC and EM programmes for all procedural skills. Discussion Residents in IM, CC and EM perceive that ultrasound-guided procedures are relevant to their practice. However, the IM residents performed fewer procedures than CC residents and EM residents at least partly because internists also lack skills in ultrasound. Training in ultrasound-guided procedures may reduce the use of landmark techniques and improve patient safety. Residents in IM, CC and EM therefore require training in ultrasound-guided procedures.

Nasce uma nova especialidade : osteopatia

2016 ◽  
Vol 2 (3) ◽  
Author(s):  
Marco Antônio Guimarães Da Silva
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Preventive Medicine ◽  
Rio De Janeiro ◽  
Obstetrics And Gynecology ◽  
Physical Medicine ◽  
National Board ◽  
Physical Medicine And Rehabilitation ◽  
Allergy And Immunology ◽  
Medical Examiners

Por circunstâncias relacionadas à minha titulação, acabei designado pela Universidade Castelo Branco do Rio de Janeiro (UCB) para avaliar uma parceria proposta pela Escola de Osteopatia de Madri (EOM). À época, em 1997, a EOM propunha que a UCB passasse a organizar academicamente os cursos de osteopatia que a referida Escola já vinha ministrando no Brasil, com vistas a, no futuro, torná-lo um curso de pós-graduação. Algumas viagens à Madri para observar a estrutura acadêmica e pedagógica da sede da EOM, condição imposta pela UCB para concretizar a parceria, me levaram a conhecer esta modalidade terapêutica, com resultados efetivamente comprovados através de trabalhos científicos.Realizadas as adaptações que se faziam necessárias, a UCB aprovou, em 2000, o curso de osteopatia, com uma carga horária de 1050 horas para a titulação de especialização acadêmica, nível Lato Sensu. A resolução do COFITO, que estabelece a osteopatia como uma especialidade da fisioterapia, levou-nos a propor ao CEPE da UCB uma complementação de 450 horas, alcançando, assim, as 1.500 horas, distribuídas ao longo de cinco anos, exigidas pela referida resolução do COFITO. A introdução desta técnica terapêutica no Brasil pela corrente Européia e a pronta intervenção do COFITO foram fatores decisivos para nos brindar com mais uma especialidade. Houvera sido a Osteopatia implantada no Brasil por influência da escola americana, talvez os rumos tomados fossem outros. Senão, vejamos. Nos EUA, a osteopatia é normalmente exercida pelo médico, que deve obter sua permissão através do National Board of Osteopatic Medical Examiners, e está dividida em Sociedades Osteopáticas que se distribuem por todas as modalidades médicas; a saber: Allergy and Immunology, Anesthesiology, Dermatology ,Emergency Medicine, Internal Medicine, Neurologists and Psychiatrists, Obstetrics and Gynecology, Occupational and Preventive Medicine, Ophthalmology and Otolaryngology, Orthopedics Pathology, Pediatrics Proctology, Radiology, Physical Medicine and Rehabilitation, Rheumatology Sports Surgery Medicine.Com o objetivo de incentivar as linhas de pesquisas na área da osteopatia, estará sendo criado, durante as III Jornadas Hispano-Lusas de Fisioterapia em Terapia Manual (Sevilha-Espanha, 5 de outubro de 2001), o Centro Internacional de Pesquisas em Osteopatia. O referido Centro, dirigido por um fisioterapeuta brasileiro com Doutorado, terá sua sede na Espanha e manterá núcleos, vinculados a Universidades, na Argentina, no Brasil, na Itália, em Portugal e na Venezuela. Esperamos, desta forma, ao lado do reconhecimento profissional já oferecido pela resolução COFITO, dar mais um passo na consolidação acadêmica da nossa mais nova modalidade terapêutica.

Critical Care Communication Skills Training for Internal Medicine Residents

MedEdPORTAL ◽  
2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Rock ◽  
Nina Gadmer ◽  
Robert Arnold ◽  
David Roberts ◽  
Asha Anandaiah ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Communication Skills ◽  
Skills Training ◽  
Communication Skills Training ◽  
Internal Medicine Residents

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 56
Author(s):  
I. Rigby ◽  
I. Walker ◽  
T. Donnon ◽  
D. Howes ◽  
J. Lord
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Medical Education ◽  
Family Medicine ◽  
Training Program ◽  
Correlation Coefficient ◽  
Training Programs ◽  
Self Assessment ◽  
Procedural Skills ◽  
Simulation Based

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

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