AEM Education and Training最新文献_第3页

The impact of a prehospital simulation on medical students’ resourcefulness, personal growth initiative, and uncertainty tolerance 院前模拟对医学生机智、个人成长主动性和不确定性容忍度的影响

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-18 DOI: 10.1002/aet2.11032

Rebekah Cole PhD, MEd, Elizabeth Pearce MA, Amy F. Hildreth MD, MHPE, Xiao Ren MS, FACHE, Leslie Vojta MD

Background

Emergency medicine (EM) physicians often practice in dynamic, high-stress, and uncertain settings with limited resources. Although simulation has been shown to enhance various aspects of student development, its impact on medical students' personal growth initiative, resourcefulness, and tolerance of uncertainty—crucial traits for managing future crises as emergency physicians—remain unclear. The purpose of this study, therefore, was to determine a high-fidelity prehospital simulation's impact on medical students' resourcefulness, personal growth, and tolerance of uncertainty.

Methods

We surveyed 107 fourth-year medical students before and after a multiday, high-fidelity prehospital simulation. The survey included items from the Intolerance of Uncertainty Scale-12 Item Form, the Personal Growth Initiative Scale, and the Resourcefulness Skills Scale. We compared students' pre- and post-simulation responses to investigate any change in their uncertainty intolerance, personal growth initiative, and resourcefulness following simulation participation.

Results

Students’ scores significantly increased following the simulation for both resourcefulness (t(106) = −6.89, p < 0.001, d = −0.67) and personal growth initiative (t(106) = −6.22, p < 0.001, d = −0.60). Effect size calculations suggest that participating in the simulation had a medium to large effect on participants’ resourcefulness and personal growth initiative. However, participants’ tolerance of uncertainty scores prior to and following the simulation did not significantly differ (t(106) = 1.66, p = 0.100, d = 0.16), indicating that the simulation had little effect on participants’ tolerance of uncertainty.

Conclusions

Our results indicate that simulation is a promising educational tool for developing students' resourcefulness and personal growth initiative so they can navigate high-stress, low-resource environments. Follow-on research is needed to determine how to leverage simulation to enhance students’ uncertainty tolerance in high-stress, low-resource environments.

背景急诊医学（EM）医生经常在动态、高压力和不确定的环境中执业，资源有限。尽管模拟训练已被证明能促进学生各方面的发展，但它对医学生个人成长的主动性、机智和对不确定性的耐受力--这些都是作为急诊医生处理未来危机的关键特质--的影响仍不明确。因此，本研究旨在确定高仿真院前模拟对医学生的机智、个人成长和对不确定性的容忍度的影响。方法我们对 107 名四年级医学生进行了为期多日的高仿真院前模拟训练前后的调查。调查内容包括不确定性不容忍量表-12 项表、个人成长主动性量表和机智技能量表中的项目。我们比较了学生模拟前和模拟后的回答，以调查他们在参加模拟后在不确定性不容忍度、个人成长主动性和足智多谋方面的变化。结果模拟后，学生在足智多谋（t(106) = -6.89，p <0.001，d = -0.67）和个人成长主动性（t(106) = -6.22，p <0.001，d = -0.60）方面的得分都有明显提高。效应大小计算表明，参加模拟活动对参与者的机智和个人成长主动性有中等到较大的影响。然而，模拟前和模拟后参与者对不确定性的容忍度得分没有显著差异（t(106) = 1.66, p = 0.100, d = 0.16），表明模拟对参与者对不确定性的容忍度影响不大。结论我们的研究结果表明，模拟是一种很有前途的教育工具，可以培养学生的机智和个人成长的主动性，使他们能够在高压力、低资源的环境中游刃有余。后续研究需要确定如何利用模拟来提高学生在高压力、低资源环境中对不确定性的承受能力。

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引用次数: 0

Beyond the symptoms: Team-based learning for social determinants in emergency medicine training 超越症状：在急诊医学培训中针对社会决定因素开展团队学习

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-14 DOI: 10.1002/aet2.11030

Layla S. Abubshait MD, Sandra Guirguis MD, Savannah Pocquette DO, Timothy Cofer DO, Angelina Omodt-Lopez MD

Background

Emergency departments serve as the front line for individuals facing acute health needs, often compounded by social determinants of health (SDoH). Integrating SDoH into emergency medicine care is vital for promptly addressing health concerns and averting future crises. This curriculum adopts a team-based approach to train emergency medicine residents in identifying and addressing SDoH, thereby delivering comprehensive and equitable care.

Methods

The curriculum employs various educational strategies, including presession readings, SDoH introductions, case simulations, debriefing sessions, panel discussions, and collaboration with other health care professionals. Evaluation via pre- and postcurriculum surveys revealed substantial enhancements in residents' comprehension, identification, and familiarity with local resources related to SDoH.

Results

Findings indicated an uptick in residents' grasp and acknowledgment of SDoH, alongside their capacity to address these factors. Posttraining Likert scores exhibited notable improvements across all domains, underscoring an augmented ability to manage SDoH in clinical practice. This curriculum amplifies residents' capability to deliver patient-centric care and advocate for health equity.

Conclusions

Continuous refinement and assessment are paramount for ensuring residents' readiness to navigate the intricate social determinants affecting patients' well-being. Ultimately, this curriculum heralds a pivotal stride toward fostering health equity and refining patient care standards within emergency medicine.

背景急诊科是满足急迫健康需求的前沿阵地，这些需求往往因健康的社会决定因素（SDoH）而加剧。将 SDoH 纳入急诊医学护理对于及时解决健康问题和避免未来危机至关重要。本课程采用以团队为基础的方法，培训急诊医学住院医师识别和解决 SDoH 问题，从而提供全面、公平的医疗服务。方法该课程采用了多种教育策略，包括课前阅读、SDoH 介绍、病例模拟、汇报会、小组讨论以及与其他医疗保健专业人员合作。通过课前和课后调查进行的评估显示，住院医师在理解、识别和熟悉与 SDoH 相关的本地资源方面有了很大提高。结果调查结果表明，住院医师对可持续发展的健康（SDoH）的掌握和认识以及应对这些因素的能力都有所提高。培训后的 Likert 分数在所有领域都有显著提高，这表明在临床实践中管理 SDoH 的能力得到了增强。该课程增强了住院医师提供以患者为中心的护理和倡导健康公平的能力。结论不断改进和评估对于确保住院医师做好准备，驾驭影响患者福祉的错综复杂的社会决定因素至关重要。最终，该课程预示着急诊医学在促进健康公平和完善患者护理标准方面迈出了关键的一步。

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引用次数: 0

Gamification in cost awareness education: Promising approach, methodological considerations 成本意识教育中的游戏化：有前途的方法和方法论方面的考虑

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-10 DOI: 10.1002/aet2.11033

Altuğ Kanbakan MD

引用次数: 0

Pendulating pain 悬浮痛

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-10 DOI: 10.1002/aet2.11031

Antonio Yaghy MD

引用次数: 0

The evaluation of video-assisted debriefing for improving performance in simulated medical student resuscitations 评估视频辅助汇报对提高医学生模拟复苏表现的作用

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-10 DOI: 10.1002/aet2.11029

James VandenBerg MD, MSc, Henry Moss DO, Courtney Wechsler MD, Chelsea Johnson MD, Matthew McRae MD, Shawn Sloan MD, Trifun Dimitrijevski MD, Sarkis Kouyoumjian MD, Jeffrey A. Kline MD, Anne Messman MD, MHPE

Objectives

Simulation-based training is commonly used in medical education. However, there is a gap in knowledge regarding best practices in debriefing. We aimed to identify novel solutions to this by adapting video-assisted debriefing (VAD) methodologies used in athletic training. We hypothesized that utilizing VAD would lead to improvements in performance during advanced cardiac life support (ACLS)-based simulations compared to traditional verbal debriefing (VD).

Methods

The study was conducted at a single medical school. Participants were fourth-year medical students engaging in ACLS simulation-based training as part of their emergency medicine rotation. After completing an ACLS-based simulation, participants received either VD or VAD and then completed a second simulation scenario. Our primary outcome was ACLS performance, graded by blinded reviewers utilizing a previously developed modified checklist. Secondary outcomes included time from cardiac arrest to initiation of cardiopulmonary resuscitation (CPR) and first defibrillation. Measurements were made before and after the interventional debrief, referred to as pre- and postdebrief. A modified Likert-scale survey was used to subjectively assess the student's overall experience.

Results

Forty-six groups of 275 students were included in the study. Mean ACLS performance score for VD and VAD postdebrief were 85% and 82%, respectively (p = 0.27). Mean time from arrest to CPR initiation for VD and VAD postdebrief groups were 20 and 24 s, respectively (p = 0.46). Mean time from arrest to defibrillation for VD and VAD postdebrief groups were 50 and 59 s, respectively (p = 0.39). For the Likert surveys, 85% or more of participants in both groups indicated that the session was “very helpful” in all survey categories.

Conclusions

VD and VAD both led to improvements in ACLS performance, time to initiation of CPR, and defibrillation among fourth-year medical students. Though postdebrief results were not statistically significantly different by comparison, overall VD led to greater improvement overall across all outcomes.

目的医学教育中常用模拟训练。然而，在汇报的最佳实践方面还存在知识空白。我们的目标是通过改编体育训练中使用的视频辅助汇报（VAD）方法，找出新的解决方案。我们假设，与传统的口头汇报（VD）相比，使用 VAD 将提高基于高级心脏生命支持（ACLS）的模拟训练中的表现。方法该研究在一所医学院进行。参与者为四年级医学生，他们在急诊医学轮转中参加了基于 ACLS 的模拟培训。完成基于 ACLS 的模拟训练后，参与者接受 VD 或 VAD，然后完成第二个模拟场景。我们的主要结果是 ACLS 的表现，由盲审人员利用之前开发的修改过的检查表进行评分。次要结果包括从心脏骤停到开始心肺复苏（CPR）和首次除颤的时间。测量在介入汇报之前和之后进行，称为汇报前和汇报后。采用改良的李克特量表调查对学生的总体体验进行主观评估。结果有 46 组 275 名学生参与了研究。汇报后 VD 和 VAD 的 ACLS 平均成绩分别为 85% 和 82%（p = 0.27）。VD 组和 VAD 后汇报组从心跳停止到开始心肺复苏的平均时间分别为 20 秒和 24 秒（p = 0.46）。VD 组和 VAD 简报后组从骤停到除颤的平均时间分别为 50 秒和 59 秒（p = 0.39）。在李克特调查中，两组均有 85% 或以上的参与者在所有调查类别中表示该课程 "非常有帮助"。结论 VD 和 VAD 都提高了四年级医学生的 ACLS 成绩、开始心肺复苏的时间和除颤能力。虽然通过比较，汇报后的结果在统计上没有显著差异，但总体而言，VD 在所有结果上都带来了更大的改善。

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引用次数: 0

PGY-2 emergency medicine residents are more efficient when paired with an early clinical medical student PGY-2 急诊科住院医师与早期临床医学学生配对时效率更高。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-03 DOI: 10.1002/aet2.11028

Nicole Liang, Corlin M. Jewell MD, Dann J. Hekman MS, Christopher Shank MA, Benjamin H. Schnapp MD, Med

Objectives

There is a concern that provide increased extraneous cognitive load when paired with residents on shift. However, this may be offset by the decrease in extraneous load they may provide to the residents they are paired with by offloading basic patient care tasks. We hypothesized that these forces may not be balanced.

Methods

We conducted a retrospective observational analysis of PGY-2 emergency medicine residents and junior medical students at a single academic emergency department (ED) in the Midwest. A series of efficiency metrics (relative value unit [RVUs], patients per hour [PPH], time to note completion, and resident assignment to disposition [RATD]) as well as one quality metric (number of return ED visits; “bouncebacks”) were compared for resident shifts in which a student was paired with the resident as well those in which no student was paired utilizing a regression model.

Results

A total of 1844 records met the inclusion criteria (214 shifts with a paired medical student and 1630 without). After covariates were adjusted for, medical student shift status was a statistically significant predictor of increases in PPH (p < 0.0001) and RVUs (p = 0.0161) but was not significantly associated with RATD (p = 0.6941), log-time to note completion (p = 0.1604), or bounceback status (p = 0.9840). Shifts where residents were paired with medical students were predicted to see an additional 1.131 (95% confidence interval [CI] 0.660–1.602) PPH and produce an additional 1.923 RVUs (95% CI 1.130–3.273) per shift relative to shifts without medical students.

Conclusions

When junior medical students were paired with a PGY-2 resident on ED shifts, there was a significant increase in the PPH and RVUs generated when compared with shifts in which no medical student was paired with them.

目标：有人担心，与住院病人配对轮班时会增加额外的认知负担。然而，通过减轻基本的患者护理任务，他们可能会减少与住院患者配对时的额外负担，这可能会抵消他们的额外负担。我们假设这些力量可能并不平衡：我们对美国中西部地区一家学术性急诊科（ED）的 PGY-2 急诊科住院医师和初级医学生进行了回顾性观察分析。利用回归模型比较了有学生与住院医师配对的住院班和没有学生配对的住院班的一系列效率指标（相对价值单位[RVUs]、每小时病人数[PPH]、完成记录的时间和住院医师分配到处置[RATD]）和一个质量指标（急诊科回访次数；"反弹"）：共有 1844 份记录符合纳入标准（214 个有医学生配对的班次和 1630 个没有医学生配对的班次）。在对协变量进行调整后，医学生轮班情况对 PPH 的增加有显著的统计学预测作用（p p = 0.0161），但与 RATD（p = 0.6941）、完成记录的对数时间（p = 0.1604）或反弹状态（p = 0.9840）无显著关联。与没有医科学生的班次相比，住院医师与医科学生配对的班次预计每班次会多收治 1.131 例 PPH（95% 置信区间 [CI] 0.660-1.602），多产生 1.923 个 RVUs（95% CI 1.130-3.273）：当初级医学生与一名 PGY-2 级住院医师在急诊室轮班时配对，与没有医学生配对的轮班相比，所产生的 PPH 和 RVU 有显著增加。

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引用次数: 0

SPARK mentorship program for emergency services assistants underrepresented in medicine interested in physician assistant programs SPARK 导师计划：面向对医生助理计划感兴趣、在医学界代表人数不足的急诊服务助理人员

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-09-24 DOI: 10.1002/aet2.11025

Aline Snietka MS, PA-C, Carl Preiksaitis MD, Catalina González-Marqués MD, MPH, Adaira Landry MD, MEd

Background

Increasing diversity in the health care workforce has been shown to improve patient health care and create psychological safety for employees who feel marginalized and underrepresented. While several measures exist for increasing racial and ethnic diversity in the physician workforce, few programs target expanding representation among physician assistants (PAs). Despite increasing the role and responsibility of PAs in the emergency department (ED), there remains a significant lack of diversity within this group. The SPARK mentorship program, a combined mentorship and educational opportunity for emergency services assistants (ESAs; also called aides and technicians) who are underrepresented in medicine (UiM), may create a pathway to recruiting diverse individuals to PA careers in emergency medicine.

Methods

Our goal was to implement and evaluate a combined didactic and mentorship curriculum focused on recruiting ESAs UIM to become PAs in the ED. Using Kern's framework, an interprofessional group created a 3-month mentorship program including individualized mentorship from senior PAs, didactic content covering the roles of PAs in the ED, and strategies to apply to PA school. This curriculum was implemented in 2022 for five ESAs following an application process. Outcomes were measured using the NIH Mentoring Evaluation Form and Munich Evaluation of Mentoring Questionnaire as well as longitudinal monitoring after the program to determine progress of ESAs toward a career as PAs.

Results

All five mentees completed the mentorship program. Postprogram surveys showed all participants described the program as meeting their expectations and being goal oriented. One-year follow-up demonstrated progress in all participants along their desired career path.

Conclusions

The SPARK mentorship program appears to be a feasible approach to creating a pathway for recruitment of ESAs UIM into the PA profession. Preliminary outcome data suggest that this curriculum was highly acceptable to participants and may have a positive impact on recruiting ESAs to become PAs. Continued evaluation is needed to determine what effect programs such as this one have on increasing diversity in the PA workforce.

背景提高医疗保健队伍的多样性已被证明可以改善患者的医疗保健，并为感到被边缘化和代表性不足的员工创造心理安全。虽然有一些措施可以提高医生队伍中的种族和民族多样性，但很少有计划旨在扩大医生助理（PA）的代表性。尽管助理医师在急诊科（ED）中的作用和责任越来越大，但这一群体中仍然严重缺乏多样性。SPARK 导师计划是一项针对在医学界代表性不足的急诊服务助理（ESAs，又称助手和技术员）的导师和教育机会相结合的计划，该计划可能会为急诊医学中的助理医师职业招募多元化人才开辟一条道路。方法我们的目标是实施并评估一套教学与导师制相结合的课程，重点是招募在急诊室就职人数不足的欧空局人员成为助理医师。利用 Kern 的框架，一个跨专业小组制定了一项为期 3 个月的指导计划，其中包括来自资深助理医师的个性化指导、涵盖助理医师在急诊室角色的教学内容以及申请助理医师学校的策略。该课程于 2022 年按照申请流程为五名 ESA 实施。通过使用美国国立卫生研究院指导评估表和慕尼黑指导评估问卷，以及项目结束后的纵向监测，对结果进行了测量，以确定 ESA 在成为 PA 的职业生涯中取得的进展。结果所有五名被指导者都完成了指导计划。计划结束后的调查显示，所有参与者都认为该计划达到了他们的期望，并以目标为导向。为期一年的跟踪调查显示，所有参与者都在他们所期望的职业道路上取得了进步。结论 SPARK 师友计划似乎是一种可行的方法，可以为招聘欧空局 UIM 进入 PA 行业开辟一条途径。初步结果数据表明，参与者对该课程的接受度很高，可能会对招募欧空局人员成为助理医师产生积极影响。需要继续进行评估，以确定此类课程对增加 PA 工作队伍多样性的影响。

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引用次数: 0

Educator's blueprint: Key considerations for using social media in survey-based medical education research 教育工作者的蓝图：在基于调查的医学教育研究中使用社交媒体的主要注意事项

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-09-23 DOI: 10.1002/aet2.11026

Kathleen Y. Ogle MD, Jeffery Hill MD, MEd, Sally A. Santen MD, PhD, Michael Gottlieb MD, Anthony R. Artino Jr. PhD, Brent Thoma MD, PhD

In this paper, we present a set of recommendations for using social media as a tool for participant recruitment in survey-based medical education research. Drawing from a limited but growing body of literature, we discuss the opportunities and challenges inherent to social media recruitment. This article builds on the authors’ previous educator's blueprints about survey design and administration. We highlight the advantages of social media, including its wide reach, cost-effectiveness, and capability to access diverse and geographically dispersed populations, which can significantly enhance the representativeness of research samples. However, we also caution against potential pitfalls, such as ethical concerns, sampling bias, and the fluid nature of social media platforms. Our recommendations are informed by both empirical evidence and best practices, aiming to provide researchers with practical advice for effectively leveraging social media in survey-based medical education research. We emphasize the importance of selecting suitable platforms and engaging with targeted demographics thoughtfully. By sharing our insights, we hope to assist fellow medical education researchers in navigating the complexities of social media recruitment, thereby enriching the quality and impact of survey-based research in this field.

在本文中，我们提出了在基于调查的医学教育研究中使用社交媒体作为参与者招募工具的一系列建议。我们从有限但不断增加的文献中，讨论了社交媒体招募所固有的机遇和挑战。本文以作者之前关于调查设计和管理的教育工作者蓝图为基础。我们强调了社交媒体的优势，包括覆盖面广、成本效益高，以及能够接触到不同的、地理位置分散的人群，这可以大大提高研究样本的代表性。不过，我们也提醒大家注意潜在的隐患，如道德问题、抽样偏差以及社交媒体平台的不稳定性。我们的建议参考了经验证据和最佳实践，旨在为研究人员提供实用建议，以便在基于调查的医学教育研究中有效利用社交媒体。我们强调，选择合适的平台并与目标人群进行深思熟虑的互动非常重要。通过分享我们的见解，我们希望能帮助医学教育研究人员了解社交媒体招募的复杂性，从而丰富该领域基于调查的研究的质量和影响力。

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引用次数: 0

Evaluation of learning in emergency medicine: An umbrella IRB protocol for education outcomes research 急诊医学学习评估：教育成果研究的总体 IRB 协议

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-09-22 DOI: 10.1002/aet2.11027

Robbie Paulsen MD, Jeffery Hill MD, Erin McDonough MD, Natalie Kreitzer MD, Emily Werff, Brittney Hahn, Sally A. Santen MD, PhD

引用次数: 0

Faculty consensus on competitiveness for the new competency-based emergency medicine standardized letter of evaluation 关于新的以能力为基础的急诊医学标准化评估书竞争力的教师共识

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-09-12 DOI: 10.1002/aet2.11024

Benjamin Schnapp MD, MEd, Morgan Sehdev MD, Caitlin Schrepel MD, Sharon Bord MD, Alexis Pelletier-Bui MD, Alai Alvarez MD, Nicole M. Dubosh MD, Yoon Soo Park PhD, Eric Shappell MD, MHPE

Background

Emergency medicine (EM) has introduced a new, competency-based standardized letter of evaluation (SLOE) template. While a previous version of the SLOE has been shown to promote a high degree of faculty consensus regarding competitiveness, this has not been shown for the new SLOE template.

Objective

The objective was to evaluate faculty consensus on competitiveness for the new EM SLOE 2.0.

Methods

Fifty mock SLOE 2.0 letters using the new template were drafted and sent to a group of experienced EM educators. The 50 letters were ranked by the experienced faculty as well as a point-based prediction model and a regression model and the results were compared.

Results

Faculty consensus on competitiveness remained strong when using the new SLOE 2.0 format. The points-based prediction model and regression model both demonstrated a high level of agreement with faculty consensus rankings for the SLOE 2.0.

Conclusions

Introduction of the new, competency-based SLOE 2.0 format did not have a deleterious effect on faculty consensus rankings of competitiveness.

背景急诊医学（EM）引入了一种新的、基于能力的标准化评估书（SLOE）模板。虽然先前版本的 SLOE 已被证明能促进教师在竞争力方面达成高度共识，但新的 SLOE 模板尚未证明这一点。目标评估教师对新的电磁学 SLOE 2.0 竞争力的共识。方法使用新模板起草 50 封模拟 SLOE 2.0 信件，并将其发送给一组经验丰富的电磁教育工作者。经验丰富的教师对这 50 封信函进行了排序，同时还使用了基于点的预测模型和回归模型，并对结果进行了比较。结果在使用新的 SLOE 2.0 格式时，教师对竞争力的共识仍然很强。基于点数的预测模型和回归模型都显示出与 SLOE 2.0 的教师共识排名高度一致。结论采用新的、基于能力的 SLOE 2.0 格式并没有对教师对竞争力的一致排名产生有害影响。

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引用次数: 0