Abstract 10739: Simulation Based Assessment of Trainee’s Performance in Post-Cardiac Arrest Resuscitation

Up to 22% of patients survive to hospital admission following out-of-hospital cardiac arrest (OHCA). Post cardiac arrest is complex and requires a multidisciplinary approach. Our aim is to assess trainee’s performance in managing post-cardiac arrest care using a high-fidelity manikin-based simulation. We also sought to obtain evidence regarding the validity of our findings. Methods: In this prospective, observational, simulation based study, participants ranging from sub interns to attending physicians evaluated and managed a post cardiac arrest patient, complicated by refractory status epilepticus. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was the critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training. Results: Forty-nine participants completed the simulation. The mean sum of critical actions completed by participants was 10/21(49%). Eleven(22%) participants verbalized a differential diagnosis for the arrest. Thirty-two(65%) recognized the abnormal electrocardiography, and consulted cardiology. Forty trainees(81%) independently decided to start target temperature management (TTM), but only 20(41%) insisted on TTM when asked to reconsider. There was an effect of level of training on critical action checklist sum scores (novice mean score [standard deviation (SD)] = 4.8 (1.8) vs. intermediate mean score (SD) = 10.4 (2.1) vs. advanced mean score (SD) = 11.6 (3.0) vs. expert mean score (SD) = 14.7 (2.2) Conclusions: High-fidelity manikin-based simulation holds promise as an assessment tool in the performance of post-cardiac arrest care. Areas for further educational initiatives to improve performance include diagnostic work-up of OHCA and implementation of TTM.

Simulation-Based Assessment of Graduate Neurology Trainees’ Performance Managing Acute Ischemic Stroke

Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees’ education which in turn may contribute to poorer outcomes in community hospitals upon graduation. Our goal was to assess graduate neurology trainee performance independent of a multi-disciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (sub-interns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was graduate neurology trainees’ critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and five attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15/22 (68%). Ninety percent of graduate neurology trainees properly administered tPA, 84% immediately stopped tPA infusion following patient deterioration, but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean score [standard deviation (SD)] = 7.2 (2.8) vs. level 2 mean score (SD) = 12.3 (2.6) vs. level 3 mean score (SD) = 13.3 (2.2) vs. level 4 mean score (SD) = 16.3 (2.4), p < .001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke, but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

Bringing the Pandemic Home: The Shifting Realities of Intimate Violence for Disabled People in the Time of COVID-19

In this article, I explore the shifting realities of intimate violence for disabled people in the midst of a global pandemic. I argue that the social and political vulnerabilities of these pandemic times, which have (often deliberately) been compounded by conservative political regimes (like the Trump administration in the United States), make it urgent for anti-violence advocates/activists to root our organizing in the intersectional crip framework of disability justice. I suggest several avenues for intervention and resistance that are grounded in radical visions of care and access advanced by such disability justice theorists as Mia Mingus (2017), Leah Lakshmi Piepzna-Samarasinha (2018), and Sins Invalid (2016). In particular, I describe how engaging with these visions and concepts opens up alternative pathways for a more inclusive, liberatory, and transformative anti-violence praxis. My purpose in writing this article is to promote further conversation about the impacts of COVID-19 on intimate violence and to support critical action centered around the lived experiences and access needs of disabled/crip peoples, especially those who have been most directly impacted by the pandemic (e.g., poor and homeless disabled people, queer and trans disabled people, and disabled people of color).

Activating Joy and Hope in Critical Literacies Instruction: Responding Pedagogically to Youth Skepticism in a YPAR Project

In the face of persistent racial injustice, critical literacy approaches to instruction frequently involve investigating and altering unjust racialized power structures through critical action. However, what happens when youth have become understandably skeptical of action for change? This analysis uses healing frameworks to explore the critical literacies of Black and Latinx youth in a youth participatory action research project that took place in the early days of the Trump administration, as well as the pedagogies employed. The salience and persistence of racial injustice in national politics and the local school district operated against youth’s reserves of hope and belief in change work, introducing tension into a project focused on transformation. As a pedagogical response, the project’s two White coteachers facilitated new pathways for critical literacies that involved joy, care, and new audiences. This response focused on joy in critical work and prompted some, though notably not all, of the youth to reengage with critical action and articulate hope for justice in their local worlds.

Assessment of Entrustable Professional Activities Using an Online Simulation Platform During Transition to Emergency Medicine Residency: A Mixed Methods Pilot Study (Preprint)

BACKGROUND The 13 Core Entrustable Professional Activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education. Five of these EPAs (EPA2: prioritizing differential, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for online assessment. OBJECTIVE For this pilot study, we created a web-based simulation platform for diagnostic assessment of these EPAs and examined its feasibility and acceptability. METHODS Four simulation cases underwent three rounds of consensus panels and pilot testing. Incoming emergency medicine interns (n=15) completed all cases, and up to 4 “look for” statements, which encompassed specific EPAs, were generated for each participant: 1) performing harmful or missing actions, 2) narrow differential or wrong final diagnosis, 3) having errors in documentation, and 4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. RESULTS All participants had at least 1 missing critical action and 40% participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of assessments (53%). Other errors included choosing the incorrect documentation (40%) and indiscriminately applying oxygen (60%). The themes to the interviews included: psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. CONCLUSIONS This study demonstrates the feasibility and acceptability of this platform for diagnostic assessment of specific EPAs. This approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides this feedback in a manner appreciated by residency leadership, and informs individualized learning plans.

Peer Mentorship: Implementation of a Resident Registered Nurse Anesthetist Mentorship Program

Nurse anesthesia residents experience high levels of stress while being enrolled in a post-baccalaureate nurse anesthesia program. Elevated levels of stress have been proven to limit one’s ability to learn and commit new material to memory, all while inhibiting their academic and clinical performance. This study represents a quality improvement project that implements a Peer Mentorship Program (PMP) into a major University in the New England area of the United States. The study utilizes descriptive statistics to determine if implementation of a peer mentorship program can help to decrease nurse anesthesia resident’s stress, while simultaneously increasing academic and clinical performance. Data gathered by the investigators of this study was composed of a Critical Action Point Checklist (CAPC); a set of objectives that were meant to be completed by the participants in order to help run a successful mentorship program. Additional data was collected using a Peer Mentorship Reflection Questionnaire at the end of the study to receive feedback about the Peer Mentorship Program. 56% of participants agreed that the Peer Mentorship Program helped to decrease stress during the study and 83.4% of participants agreed that they would like to see the Peer Mentorship Program continue for future cohorts at their nurse anesthesia program. The findings of this study suggest that more Nurse Anesthesia Programs should work to incorporate a Peer Mentorship Program for their nurse anesthesia residents to help develop safe, high-quality anesthesia providers for the future.

"Encontré tres palabras para jugar hoy: exacto, excéntrico, extremo": el efecto performático en los cuentos de Nadine Alemán

Current Argentinean Patagonian narrative possesses Nadine Alemán (Esquel, 1977) as one of its most suggestive and creative voices. This assertion is based on her capacity to construct a narrative imaginary that produces performance effects, derived from the confluence and evocation of other languages that can be found in the literary reception of 17 simples cuentos (2006) and of El cura y la sucia (2012). The traditional boundaries that tend to restrict literature to a specific field of critical action seem, in consequence, to become fuzzy. Thus, performance ―as a “methodological lense”, according to Diana Taylor― is made into a certain possibility that widens perspectives to approach this Spanish American writing proposal.