Implementation science (IS) is an approach focused on increasing the application of evidence-based health interventions into practice, through purposive and thoughtful planning to maximize uptake, scalability, and sustainability. Many of these principles can be readily applied to medical education, to help augment traditional approaches to curriculum design. In this paper, we summarize key components of IS with an emphasis on application to the medical educator.
Free open-access medical education (FOAM) is extremely popular among learners and educators despite lacking the traditional peer review process. Despite the potential for inaccurate, low-quality, or biased content, little has been published describing FOAM authors.
We performed a cross-sectional analysis of 12 months of content from the top 25 blogs in the 2020 Social Media Index from August 2020–2021. We recorded the number of posts per site and descriptive characteristics of authors, including gender affiliation, conflicts of interest (COI) statements, and type of practice (academic, community, or hybrid).
We identified 2141 posts by 1001 authors. More than half were produced by six websites: EM Docs (266), Life in the Fast Lane (232), EMCrit (188), ALiEM (185), Don't Forget the Bubbles (181), and Rebel EM (174). Most content (1680 posts, 78.5%) lacked a COI statement. Authors were mostly academic (89%), mostly held MD degrees (67.4%), and were mostly men (59.7%). Geographically, most FOAM authors reside in the United States (59.5%), Canada (22.42%), or the United Kingdom (9.4%).
Of all the posts in the top 25 sites in 2020, more than half came from six sites, and authors were largely North American men in academics with MD degrees. Learners, content creators, and educators should consider the ways in which a more diverse authorship pool might bring value to the FOAM educational experience.
This study assesses the effectiveness of clinical simulation-based training in boosting self-perceived confidence for using upstander communication skills to confront racism, discrimination, and microaggressions (RDM).
We conducted an observational cohort study with emergency medicine professionals at the 2023 Scientific Assembly of the American Academy of Emergency Medicine in New Orleans, Louisiana. The study featured a clinical simulation-based training on upstander communications skills session followed by small- and large-group debriefs. Participants completed pre- and post-training questionnaires assessing demographics and confidence in health equity competencies. This survey was used in a previous study with emergency medicine residents. Data were analyzed using an independent Student's t-test, with a significance threshold of 0.05.
Thirty-two individuals participated in the simulation-based training, and 24 completed surveys, with a 75% response rate. Most participants were non-Hispanic (24, 85.7%) and women (18, 64%), with racial demographics mostly White (8, 28.6%), Black or African American (8, 28.6%), and Asian (6, 21.4%). After the workshop, there was a notable increase in self-perceived ability and confidence in identifying RDM (from 7 ± 3.2 to 8.6 ± 1.6, p < 0.003), using upstander communication tools (from 6.1 ± 3.5 to 8.5 ± 1, p < 0.0001), and the likelihood of intervening in RDM situations (from 7.1 ± 3.3 to 8.8 ± 1.1, p < 0.0002).
The clinical simulation-based training significantly improved participants' confidence and self-perceived ability to address RDM in simulated clinical environments. This training method is a promising tool for teaching health equity topics in clinical medicine.
We offered a workshop at the 2023 annual meeting of the Society for Academic Emergency Medicine to teach the Sort–Assess–Lifesaving Interventions–Treatment/Transport (SALT) triage protocol for responding to mass casualty incidents (MCIs) using an immersive virtual reality (VR) simulator. Here, we report workshop outcomes.
After a 1-h didactic on the basics of triage protocols, workshop participants rotated through three skill stations at which learners learned how to use the VR headset and controllers, practiced applying SALT triage skills through a tabletop exercise, and then finally used our VR simulator for training responses to MCIs. During their encounter with VR, participants applied their new knowledge to triaging and treating the victims of an explosion in a virtual subway station. After a brief orientation, participants entered the scene to treat and triage virtual patients who had various life-threatening (e.g., acute arterial bleed, penetrating injury, pneumothorax, amputations) and non–life-threatening injuries (lacerations, sprains, hysteria, confusion). The simulator generated a performance report for each workshop attendee to be used for debriefing by a skilled facilitator.
Participants were mostly trainees (residents), all of whom properly initiated their encounter with global sort commands (walk and wave) to identify the most critically injured. On average, participants correctly treated 92% of 18 injuries, with all bleeding injuries being properly controlled (tourniquets or wound packing). On average, participants correctly tagged 87.7% of 11 patients, but only took the pulse of 67% of the 11 patients. Learners had difficulty with cases involving embedded shrapnel and properly tagging patients who were stable after treatments.
Our VR simulator provided a practical, portable, reproducible training and assessment system for preparing future emergency medical systems (EMS) medical directors to teach their EMS professionals the triage and lifesaving intervention treatment skills needed to save lives.
Community engagement is increasingly recognized as a necessity in addressing intractable racial and ethnic health disparities in the United States. However, institutions have not adequately trained resident physicians in developing symbiotic community partnerships that preserve community autonomy and identity without exploitation. Our goals were to highlight the experiences of expert academic emergency physicians in creating innovative, community-driven, and anti-racist solutions to achieving measurable equity in health outcomes and to introduce a novel framework entitled the Social Change Method to take a community-embedded intervention from concept to creation.
The methodology was based on the development of a didactic session at the 2023 SAEM Annual Meeting. The three novel initiatives discussed were Emergency Medicine Remix (EMR); Trust, Research, Access, and Prevention (TRAP) Medicine; and The Health Equity Accelerator (HEA). A team of multi-institutional experts convened to develop the session objectives through priority setting.
Our expert panel discussed successes and challenges encountered while using evidence-informed strategies to conduct their community-based programming. Participant questions were centered on fostering sustainability, emphasizing the importance of carefully crafted interventions in the face of uncertain legislative challenges and strategies to empower others.
Emergency medicine residency education should incorporate training on methods to leverage community partnerships to improve individual and community health outcomes. The Social Change Method can be used as a conceptual framework to generate easily re-creatable and scalable partnerships that establish trust and forge relationships that honor identity and autonomy without exploiting community members.
Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape.
The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation-based education (SBE) and actively involved in EM residency education.
Through primary and secondary literature searches, the SLANG-EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self-paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments.
Instructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small-group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner-centered debriefing, rapid-cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner-centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student-centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, “Delivering Effective Education to the Next Generation,” at the 2023 SAEM Annual Meeting.
Precision medicine, sometimes referred to as personalized medicine, is rapidly changing the possibilities for how people will engage health care in the near future. As technology to support precision medicine exponentially develops, there is an urgent need to proactively improve our understanding of precision medicine and pose important research questions (RQs) related to its inclusion in the education and training of future emergency physicians.
A seven-step process was employed to develop a research agenda exploring the intersection of precision and emergency medicine education/training. A literature search of articles about precision medicine was conducted first, which informed the creation of future four scenarios in which trainees and practicing physicians regularly discuss and incorporate precision medicine tools into their discussions and work. Based on these futurist narratives, potential education RQs were generated by an expert panel. A total of 59 initial questions were subsequently categorized and refined to a priority list through a nominal group voting method. The top/priority questions were presented at the 2023 SAEM Consensus Conference on Precision Medicine, Austin, Texas, for further input.
Eight high-value education RQs were developed, reflecting a holistic view of the challenges and opportunities for precision medicine education in the knowledge, skills, and attitudes relevant to emergency medicine. These questions contend with topics such as most effective pedagogical methods; intended resulting outcomes and behaviors; the generational differences between practicing emergency physicians, educators, and future trainees; and the desires and expectations of patients.
Emergency medicine and emergency physicians must be prepared to understand precision medicine and incorporate this information into their “toolbox” of thinking, problem solving, and communication with patients and colleagues. This research agenda on how best to educate future emergency physicians in the use of personalized data to provide optimal health care is the focus of this article.
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