Megan Rivera, Michael Gottlieb, Katarzyna Gore, Samiya Natesan-Torres, Sreeja Natesan
Feedback is essential to professional development in emergency medicine, yet its impact hinges on the learner's ability to receive and apply it—an often-overlooked element of the feedback equation. In the high-acuity, time-pressured setting of the ED, creating conditions for meaningful feedback reception can be particularly challenging. This EM Download reframes feedback through the lens of the educational alliance and highlights key strategies to foster learner receptivity: cultivating trust, promoting active learning, recognizing appropriate timing, and nurturing a growth mindset. Using practical examples and the “Ask-Tell-Ask” model, this piece offers evidence-informed guidance for building a feedback culture that empowers learners and strengthens clinical education in the ED.
{"title":"Helping Learners Receive Feedback in the Emergency Department","authors":"Megan Rivera, Michael Gottlieb, Katarzyna Gore, Samiya Natesan-Torres, Sreeja Natesan","doi":"10.1002/aet2.70085","DOIUrl":"https://doi.org/10.1002/aet2.70085","url":null,"abstract":"<div>\u0000 \u0000 <p>Feedback is essential to professional development in emergency medicine, yet its impact hinges on the learner's ability to receive and apply it—an often-overlooked element of the feedback equation. In the high-acuity, time-pressured setting of the ED, creating conditions for meaningful feedback reception can be particularly challenging. This EM Download reframes feedback through the lens of the <i>educational alliance</i> and highlights key strategies to foster learner receptivity: cultivating trust, promoting active learning, recognizing appropriate timing, and nurturing a growth mindset. Using practical examples and the “Ask-Tell-Ask” model, this piece offers evidence-informed guidance for building a feedback culture that empowers learners and strengthens clinical education in the ED.</p>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaime Jordan, Kerry McCabe, Bo Burns, Arlene S. Chung, Laura R. Hopson
Background
Duration of tenure of emergency medicine (EM) program directors (PD) has decreased in recent decades. We sought to explore the perspectives of EM PDs on their job experiences to identify causes and strategies to promote longevity in the role.
Methods
Using a constructivist paradigm, we conducted semi-structured interviews of EM PDs who had recently (within 24 months) transitioned out of the PD role or were contemplating a transition. We used purposive sampling to seek diversity of participants with regard to gender, region of practice, and program training format. We collected data from January to August 2024. Three researchers independently performed a thematic analysis of interview transcripts. We resolved discrepancies through in-depth discussion and negotiated consensus.
Results
12 PDs participated. Our analysis revealed that PDs came into their roles with idealism and a desire to meaningfully impact their trainees, programs, and patients. They experienced fulfillment from having an impact on their trainees and the field of EM, performing an intellectually challenging job, solving problems, and leading their teams to success. They struggled with the high administrative burden, lack of support and resources, challenging interpersonal interactions, and a substantial burden of responsibility oftentimes coupled with limited power to enact change. The misalignment between their ideals and goals and the realities of their job contributed to emotional exhaustion, burnout, and a desire to leave the role. Participants had recommendations at the individual, institutional, and organizational levels to support PDs in their careers.
Conclusion
This study illuminates the positive and negative experiences of PDs in their roles and provides insight into how PD longevity can be supported.
{"title":"One Thousand Cuts: Insights From a Qualitative Study Exploring Emergency Medicine Program Director Attrition and Career Experiences","authors":"Jaime Jordan, Kerry McCabe, Bo Burns, Arlene S. Chung, Laura R. Hopson","doi":"10.1002/aet2.70088","DOIUrl":"https://doi.org/10.1002/aet2.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Duration of tenure of emergency medicine (EM) program directors (PD) has decreased in recent decades. We sought to explore the perspectives of EM PDs on their job experiences to identify causes and strategies to promote longevity in the role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a constructivist paradigm, we conducted semi-structured interviews of EM PDs who had recently (within 24 months) transitioned out of the PD role or were contemplating a transition. We used purposive sampling to seek diversity of participants with regard to gender, region of practice, and program training format. We collected data from January to August 2024. Three researchers independently performed a thematic analysis of interview transcripts. We resolved discrepancies through in-depth discussion and negotiated consensus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>12 PDs participated. Our analysis revealed that PDs came into their roles with idealism and a desire to meaningfully impact their trainees, programs, and patients. They experienced fulfillment from having an impact on their trainees and the field of EM, performing an intellectually challenging job, solving problems, and leading their teams to success. They struggled with the high administrative burden, lack of support and resources, challenging interpersonal interactions, and a substantial burden of responsibility oftentimes coupled with limited power to enact change. The misalignment between their ideals and goals and the realities of their job contributed to emotional exhaustion, burnout, and a desire to leave the role. Participants had recommendations at the individual, institutional, and organizational levels to support PDs in their careers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study illuminates the positive and negative experiences of PDs in their roles and provides insight into how PD longevity can be supported.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to Be Coachable","authors":"Jeremy Branzetti, Richard C. Winters","doi":"10.1002/aet2.70090","DOIUrl":"https://doi.org/10.1002/aet2.70090","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emergency medicine (EM) training programs vary in how residents are exposed to clinical responsibilities. Transitioning to new roles often causes stress and uncertainty. Structured orientation programs may alleviate these challenges.
Methods
We implemented three role-specific orientation sessions targeting post-graduate year (PGY)-2, PGY-3, and PGY-4 EM residents at a 4-year residency program. Pre- and post-surveys measured comfort with clinical, supervisory, and system-based skills. Paired t-tests assessed changes.
Results
All three orientation sessions significantly improved self-reported comfort across various domains. Participating PGY-2 residents (n = 10) showed increased preparedness for managing critical conditions. PGY-3 residents (n = 6) demonstrated improved confidence in procedural supervision and knowledge of rare procedures. PGY-4 residents (n = 11) transitioning to attending roles showed the largest gains, particularly in billing and medico-legal domains.
Conclusion
Structured orientation improves EM resident readiness for role transitions. These findings support the integration of targeted educational interventions to enhance performance and preparedness.
{"title":"Enhancing Emergency Medicine Resident Transitions: The Impact of Structured Orientation Programs on Comfort and Preparedness","authors":"Jessica Baez, Erin McDonough","doi":"10.1002/aet2.70080","DOIUrl":"https://doi.org/10.1002/aet2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency medicine (EM) training programs vary in how residents are exposed to clinical responsibilities. Transitioning to new roles often causes stress and uncertainty. Structured orientation programs may alleviate these challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We implemented three role-specific orientation sessions targeting post-graduate year (PGY)-2, PGY-3, and PGY-4 EM residents at a 4-year residency program. Pre- and post-surveys measured comfort with clinical, supervisory, and system-based skills. Paired <i>t</i>-tests assessed changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All three orientation sessions significantly improved self-reported comfort across various domains. Participating PGY-2 residents (<i>n</i> = 10) showed increased preparedness for managing critical conditions. PGY-3 residents (<i>n</i> = 6) demonstrated improved confidence in procedural supervision and knowledge of rare procedures. PGY-4 residents (<i>n</i> = 11) transitioning to attending roles showed the largest gains, particularly in billing and medico-legal domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Structured orientation improves EM resident readiness for role transitions. These findings support the integration of targeted educational interventions to enhance performance and preparedness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shayan Novin, Tehrim Younas, Jessie Xu, Samuel Graef, Nima Karimi, Maggie Xu, Jo-Anne Petropoulos, Quang Ngo, Elif Bilgic
Background
Medical trainees have limited opportunities to practice certain pediatric emergency medicine (PEM) procedures in the clinical setting. Simulation-based education provides an opportunity for trainees to improve their technical and non-technical skills. This scoping review aimed to explore the ways in which simulation has been used to train and assess medical learners.
Methods
A search was conducted from 2011 to August 2022 using MEDLINE, OVID Embase, OVID Emcare, and Cochrane Trials, among others. The review included empirical studies that used simulation for training medical trainees in four essential pediatric procedures: intubation, lumbar puncture, intraosseous insertion, and chest tube insertion. Six reviewers independently screened titles, abstracts, and full texts. Data were recorded, stored, and summarized in a standardized spreadsheet.
Results
The search retrieved 4073 articles, of which 207 underwent full-text screening. Data were extracted from 107 studies. Among these, 69 studies focused exclusively on intubation skills, 19 studies on lumbar puncture, 10 studies on intraosseous insertion, and two studies on chest tube insertion. The majority of studies (n = 61) involved residents, while 15 studies focused on medical students. Training platforms included mannequins (n = 84), ex-vivo models (n = 6), task trainers (n = 4), and standardized patients (n = 1). Competency was largely assessed using an assessment tool (n = 45) as the sole assessment method.
Conclusions
Simulation-based training and assessment can support medical learners in developing key technical and non-technical skills related to PEM procedures. However, there is a need for diversification of simulation platforms used, expansion of procedures targeted in simulation-based training and assessment programs, and creation of standardized and procedure-specific assessments.
{"title":"Simulation Platforms to Train and Assess Pediatric Acute Care Procedural Skills: A Scoping Review","authors":"Shayan Novin, Tehrim Younas, Jessie Xu, Samuel Graef, Nima Karimi, Maggie Xu, Jo-Anne Petropoulos, Quang Ngo, Elif Bilgic","doi":"10.1002/aet2.70083","DOIUrl":"https://doi.org/10.1002/aet2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medical trainees have limited opportunities to practice certain pediatric emergency medicine (PEM) procedures in the clinical setting. Simulation-based education provides an opportunity for trainees to improve their technical and non-technical skills. This scoping review aimed to explore the ways in which simulation has been used to train and assess medical learners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was conducted from 2011 to August 2022 using MEDLINE, OVID Embase, OVID Emcare, and Cochrane Trials, among others. The review included empirical studies that used simulation for training medical trainees in four essential pediatric procedures: intubation, lumbar puncture, intraosseous insertion, and chest tube insertion. Six reviewers independently screened titles, abstracts, and full texts. Data were recorded, stored, and summarized in a standardized spreadsheet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search retrieved 4073 articles, of which 207 underwent full-text screening. Data were extracted from 107 studies. Among these, 69 studies focused exclusively on intubation skills, 19 studies on lumbar puncture, 10 studies on intraosseous insertion, and two studies on chest tube insertion. The majority of studies (<i>n</i> = 61) involved residents, while 15 studies focused on medical students. Training platforms included mannequins (<i>n</i> = 84), ex-vivo models (<i>n</i> = 6), task trainers (<i>n</i> = 4), and standardized patients (<i>n</i> = 1). Competency was largely assessed using an assessment tool (<i>n</i> = 45) as the sole assessment method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Simulation-based training and assessment can support medical learners in developing key technical and non-technical skills related to PEM procedures. However, there is a need for diversification of simulation platforms used, expansion of procedures targeted in simulation-based training and assessment programs, and creation of standardized and procedure-specific assessments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Pokrajac, Kimberly Schertzer, Deborah Hsu, Stefanie S. Sebok-Syer
{"title":"Procedural Skills and Emergency Medicine Common Program Requirements: It's Time to Address Skill Decay","authors":"Nicholas Pokrajac, Kimberly Schertzer, Deborah Hsu, Stefanie S. Sebok-Syer","doi":"10.1002/aet2.70081","DOIUrl":"https://doi.org/10.1002/aet2.70081","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sydney Krispin, Eric Kontowicz, Brett Faine, Michael Takacs, Karisa K. Harland, J. Priyanka Vakkalanka, Kelli Wallace, Andrew Nugent, Nicholas M. Mohr
Objectives
Emergency medicine (EM) residency programs require participation in scholarly activity. In 2017, we launched a formal Resident Research Program (RRP) for physician residents in our 3-year accredited residency program. We aimed to measure the association between the implementation of the RRP and resident scholarly productivity.
Methods
This analysis was a before-after study of residents in a Midwestern university-based EM residency program (7–10 per class) graduating between 2013 and 2023. The RRP was implemented in July 2017 and offered resources and requirements; our study compared outcomes before and after the launch of the program. We provided a dedicated training program study coordinator, 24-h in-house research assistants, faculty/research staff mentorship, and research funding. Residents were required to complete a hypothesis-driven research project and submit an abstract to a professional meeting or manuscript for publication. We tracked scholarly productivity per class, including publications, presentations, first-author manuscripts, and faculty publications with a resident. We measured the association between the RRP and scholarly productivity through univariate Poisson regression models to report the unadjusted rate ratio (RR) with 95% confidence intervals (95% CI).
Results
Ninety residents were included (n = 43 after RRP launch). Annual mean resident scholarly productivity increased post-intervention for publications (10.4 vs. 6.2 publications per class, RR 1.68, 95% CI 1.09–2.59), presentations (7.4 vs. 3.7 abstracts per class, RR 2.01, 95% CI 1.19–3.42), and first-author publications (5.8 vs. 2.2 publications per class, RR 2.66, 95% CI 1.40–5.09). No significant change in faculty co-authors was observed (12.8 vs. 9.5, RR 1.35, 95% CI 0.95–1.92).
Conclusions
The implementation of a structured RRP was associated with increased resident scholarly productivity. The targeted research resources served as both a strategy to support resident research and enhance departmental academic engagement. Future research should examine the perceptions, quality, and impact of scholarly activity requirements on residents.
目的急诊医学（EM）住院医师项目需要参与学术活动。2017年，我们为住院医师推出了正式的住院医师研究计划（RRP），该计划为期3年。我们的目的是衡量RRP的实施与居民学术生产力之间的关系。方法对2013年至2023年毕业的中西部大学EM住院医师项目（每班7-10人）的住院医师进行了前后研究。RRP于2017年7月实施，并提供了资源和要求；我们的研究比较了项目启动前后的结果。我们提供了专门的培训项目研究协调员，24小时内部研究助理，教师/研究人员指导和研究资金。居民被要求完成一个假设驱动的研究项目，并向专业会议提交摘要或手稿发表。我们跟踪每堂课的学术生产力，包括出版物、演讲、第一作者手稿和一位住院医师的教员出版物。我们通过单变量泊松回归模型测量RRP与学术生产力之间的关联，以95%置信区间（95% CI）报告未调整率比（RR）。结果RRP启动后共纳入90名居民（n = 43）。干预后，发表文章（每类10.4篇对6.2篇，RR = 1.68, 95% CI = 1.09-2.59）、报告（每类7.4篇对3.7篇摘要，RR = 2.01, 95% CI = 1.19-3.42）和第一作者发表文章（每类5.8篇对2.2篇，RR = 2.66, 95% CI = 1.40-5.09）的年平均学术生产力均有所提高。教职工共同作者未见显著变化（12.8 vs. 9.5, RR 1.35, 95% CI 0.95-1.92）。结论：结构化RRP的实施与住院医师学术生产力的提高有关。有针对性的研究资源既是支持居民研究的战略，也是加强部门学术参与的战略。未来的研究应该考察居民对学术活动要求的看法、质量和影响。
{"title":"Resident Scholarly Activity and Productivity Outcomes Before and After Implementing a Structured Research Program: A Before–After Study","authors":"Sydney Krispin, Eric Kontowicz, Brett Faine, Michael Takacs, Karisa K. Harland, J. Priyanka Vakkalanka, Kelli Wallace, Andrew Nugent, Nicholas M. Mohr","doi":"10.1002/aet2.70082","DOIUrl":"https://doi.org/10.1002/aet2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Emergency medicine (EM) residency programs require participation in scholarly activity. In 2017, we launched a formal Resident Research Program (RRP) for physician residents in our 3-year accredited residency program. We aimed to measure the association between the implementation of the RRP and resident scholarly productivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis was a before-after study of residents in a Midwestern university-based EM residency program (7–10 per class) graduating between 2013 and 2023. The RRP was implemented in July 2017 and offered resources and requirements; our study compared outcomes before and after the launch of the program. We provided a dedicated training program study coordinator, 24-h in-house research assistants, faculty/research staff mentorship, and research funding. Residents were required to complete a hypothesis-driven research project and submit an abstract to a professional meeting or manuscript for publication. We tracked scholarly productivity per class, including publications, presentations, first-author manuscripts, and faculty publications with a resident. We measured the association between the RRP and scholarly productivity through univariate Poisson regression models to report the unadjusted rate ratio (RR) with 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety residents were included (<i>n</i> = 43 after RRP launch). Annual mean resident scholarly productivity increased post-intervention for publications (10.4 vs. 6.2 publications per class, RR 1.68, 95% CI 1.09–2.59), presentations (7.4 vs. 3.7 abstracts per class, RR 2.01, 95% CI 1.19–3.42), and first-author publications (5.8 vs. 2.2 publications per class, RR 2.66, 95% CI 1.40–5.09). No significant change in faculty co-authors was observed (12.8 vs. 9.5, RR 1.35, 95% CI 0.95–1.92).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The implementation of a structured RRP was associated with increased resident scholarly productivity. The targeted research resources served as both a strategy to support resident research and enhance departmental academic engagement. Future research should examine the perceptions, quality, and impact of scholarly activity requirements on residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Statement of Support for Focused Pediatric Emergency Medicine Training in Emergency Medicine Residency","authors":"Sarah C. Cavallaro, Jennifer M. Mitzman","doi":"10.1002/aet2.70077","DOIUrl":"https://doi.org/10.1002/aet2.70077","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry J. Higby, John D. Hoyle Jr., Joshua D. Mastenbrook, Philip A. Pazderka, Sarah Fichuk, Austin Wilkinson, Caleb Porter
Background
Pediatric prehospital dosing errors occur at high rates, up to 60% for epinephrine. Senior emergency medicine residents (EMR) in the Western Michigan University Homer Stryker MD School of Medicine (WMed) residency respond as EMS physicians to cardiac arrests in Kalamazoo County. We sought to determine error rates for weight estimation, epinephrine doses, dose administration mechanics, and esophageal intubation (EI) recognition by EMRs at the end of the PGY-1 year, during EMS physician training summative testing.
Methods
Sixteen PGY-1 EMRs were observed during a simulation: 5-year-old with an EMS EI in asystole requiring multiple epinephrine administrations by the EMR. All EMRs had completed Pediatric Advanced Life Support (PALS). Two observers scored performance. Scenarios were recorded. Recordings and scores were reviewed and discussed by observers. Any disagreements were resolved by consensus. Dosing error was defined as > 20% difference from the correct dose.
Results
All EMRs obtained correct weight with 15 (94%; 72.0%, 99.0%) using length-based tape (LBT) and one (6%) guessing. Four near-miss errors occurred with the LBT. Four (25%) and two (12.5%) of the first and second epinephrine doses, respectively, were incorrect. Five (50%) errors occurred using graduations on the preloaded syringe, and five (50%) were due to air bubbles in the administration syringe. There were no ten-fold errors. Three (19%) EMRs took 3 attempts to assemble the preloaded syringe, six (38%) did not screw the preloaded syringe together correctly, seven (44%) had difficulty attaching a stopcock to the preloaded syringe, and 14 (88%) did not prime the stopcock. One (6%) failed to recognize EI.
Conclusions
PALS-certified PGY-1 EMRs, accurately estimated patient weight, had a high rate of epinephrine dosing errors and frequent difficulty assembling preloaded syringes. To address these errors, training will be developed that includes a checklist, LBT use, weight determination hierarchy, assembling epinephrine preloaded syringes, techniques for appropriate dose administration, and recognition of EI.
{"title":"Epinephrine Dosing by Emergency Medicine Residents During a Simulated Prehospital Pediatric Cardiac Arrest","authors":"Henry J. Higby, John D. Hoyle Jr., Joshua D. Mastenbrook, Philip A. Pazderka, Sarah Fichuk, Austin Wilkinson, Caleb Porter","doi":"10.1002/aet2.70073","DOIUrl":"https://doi.org/10.1002/aet2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pediatric prehospital dosing errors occur at high rates, up to 60% for epinephrine. Senior emergency medicine residents (EMR) in the Western Michigan University Homer Stryker MD School of Medicine (WMed) residency respond as EMS physicians to cardiac arrests in Kalamazoo County. We sought to determine error rates for weight estimation, epinephrine doses, dose administration mechanics, and esophageal intubation (EI) recognition by EMRs at the end of the PGY-1 year, during EMS physician training summative testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixteen PGY-1 EMRs were observed during a simulation: 5-year-old with an EMS EI in asystole requiring multiple epinephrine administrations by the EMR. All EMRs had completed Pediatric Advanced Life Support (PALS). Two observers scored performance. Scenarios were recorded. Recordings and scores were reviewed and discussed by observers. Any disagreements were resolved by consensus. Dosing error was defined as > 20% difference from the correct dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All EMRs obtained correct weight with 15 (94%; 72.0%, 99.0%) using length-based tape (LBT) and one (6%) guessing. Four near-miss errors occurred with the LBT. Four (25%) and two (12.5%) of the first and second epinephrine doses, respectively, were incorrect. Five (50%) errors occurred using graduations on the preloaded syringe, and five (50%) were due to air bubbles in the administration syringe. There were no ten-fold errors. Three (19%) EMRs took 3 attempts to assemble the preloaded syringe, six (38%) did not screw the preloaded syringe together correctly, seven (44%) had difficulty attaching a stopcock to the preloaded syringe, and 14 (88%) did not prime the stopcock. One (6%) failed to recognize EI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PALS-certified PGY-1 EMRs, accurately estimated patient weight, had a high rate of epinephrine dosing errors and frequent difficulty assembling preloaded syringes. To address these errors, training will be developed that includes a checklist, LBT use, weight determination hierarchy, assembling epinephrine preloaded syringes, techniques for appropriate dose administration, and recognition of EI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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