scholarly journals Critical Electrocardiogram Curriculum: Setting the Standard for Flipped-Classroom EKG Instruction

2019 ◽  
Vol 21 (1) ◽  
pp. 52-57 ◽  
Author(s):  
William Burns ◽  
Nicholas Hartman ◽  
P. Weygandt ◽  
Shanna Jones ◽  
Holly Caretta-Weyer ◽  
...  

Introduction: Electrocardiogram (EKG) interpretation is integral to emergency medicine (EM).1 In 2003 Ginde et al. found 48% of emergency medicine (EM) residency directors supported creating a national EKG curriculum.2 No formal national curriculum exists, and it is unknown whether residents gain sufficient skill from clinical exposure alone. Methods: The authors sought to assess the value of this EKG curriculum, which provides exposure to critical EKG patterns, a framework for EKG interpretation when the diagnosis is not obvious, and implementation guidelines and open access to any interested residency. The Foundations of Emergency Medicine (FoEM) EKG I course launched in January 2016, followed by EKG II in July 2017; they are benchmarked to post-graduate year 1 (PGY) and PGY2 level learners, respectively. Selected topics included 15 published critical EKG diagnoses and 33 selected by the authors.5 Cases included presenting symptoms, EKGs, and Free Open Access Medical Education (FOAM) links. Full EKG interpretations and question answers were provided. Results: Enrollment during 2017-2018 included 37 EM residencies with 663 learners in EKG I and 22 EM residencies with 438 learners in EKG II. Program leaders and learners were surveyed annually. Leaders indicated that content was appropriate for intended PGY levels. Leaders and learners indicated the curriculum improved the ability of learners to interpret EKGs while working in the emergency department (ED). Conclusion: There is an unmet need for standardization and improvement of EM resident EKG training. Leaders and learners exposed to FoEM EKG courses report improved ability of learners to interpret EKGs in the ED.

2021 ◽  
Vol 13 (5) ◽  
pp. 699-710
Author(s):  
Kristen Grabow Moore ◽  
Andrew Ketterer ◽  
Natasha Wheaton ◽  
Paul Logan Weygandt ◽  
Holly A. Caretta-Weyer ◽  
...  

ABSTRACT Background Leaders in graduate medical education must provide robust clinical and didactic experiences to prepare residents for independent practice. Programs traditionally create didactic experiences individually, requiring tremendous resources with variable content exposure and quality. Objective We sought to create and implement a free, open access, learner-centric, level-specific, emergency medicine (EM) residency curriculum. Methods We developed Foundations of Emergency Medicine (FoEM) Foundations I and II courses using Kern's model of curriculum development. Fundamental topics were identified through content guidelines from the American Board of Emergency Medicine. We incorporated learner-centric strategies into 2 flipped classroom, case-based courses targeting postgraduate year (PGY) 1 and PGY-2 residents. The curriculum was made freely available online in 2016. Faculty and resident users were surveyed annually for feedback, which informed iterative refinement of the curriculum. Results Between 2016 and 2020, registration for FoEM expanded from 2 sites with 36 learners to 154 sites and 4453 learners. In 2019, 98 of 102 (96%) site leaders and 1618 of 2996 (54%) learners completed the evaluative survey. One hundred percent of responding leaders and 93% of learners were “satisfied” or “very satisfied” with FoEM content. Faculty and residents valued FoEM's usability, large volume of content, quality, adaptability, organization, resident-faculty interaction, and resident-as-teacher opportunities. Challenges to implementation included resident attendance, conference structure, technology limitations, and faculty engagement. Conclusions We developed and implemented a learner-centric, level-specific, national EM curriculum that has been widely adopted in the United States.


CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham

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.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie

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.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
A. P. Javidan ◽  
◽  
K. Hansen ◽  
I. Higginson ◽  
P. Jones ◽  
...  

Abstract Objective To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block Methods Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.


2019 ◽  
Vol 3 (4) ◽  
pp. 421-424
Author(s):  
Christopher Parker ◽  
Wesley Eilbert ◽  
Timothy Meehan ◽  
Christopher Colbert

Colpocephaly is a form of congenital ventriculomegaly characterized by enlarged occipital horns of the lateral ventricles with associated neurologic abnormalities. The diagnosis of colpocephaly is typically made in infancy. Its diagnosis in adulthood without associated clinical symptoms is exceptionally rare. We report a case of colpocephaly diagnosed incidentally in an adult without neurologic abnormalities in the emergency department. To our knowledge, this is only the ninth reported case in an asymptomatic adult and the first to be described in the emergency medicine literature.


2019 ◽  
Vol 21 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Ashley Rider ◽  
Tiffany Anaebere ◽  
Mariko Nomura ◽  
David Duong ◽  
Charlotte Wills

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.


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