Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8194H
Eleanor M Birch, Theodore McClean, Scott Szymanski
Non-obstetric vulvar hematoma is a rare but clinically important diagnosis in the emergency department for which there is no consensus on optimal diagnosis or management. We present a case of non-obstetric vulvar hematoma that occurred after minimal trauma in a young, otherwise healthy woman who presented with labial swelling after consensual digital penetration, initially managed conservatively but ultimately requiring surgical drainage. Although a rare presentation in the emergency department, prompt identification, diagnosis, and management of vulvar hematoma is crucial to appropriately treat complications including pain, hemodynamically significant hemorrhage, urinary obstruction, and soft tissue necrosis.
{"title":"Computed Tomography Findings in Non-Obstetric Vulvar Hematoma: A Case Report.","authors":"Eleanor M Birch, Theodore McClean, Scott Szymanski","doi":"10.21980/J8194H","DOIUrl":"10.21980/J8194H","url":null,"abstract":"<p><p>Non-obstetric vulvar hematoma is a rare but clinically important diagnosis in the emergency department for which there is no consensus on optimal diagnosis or management. We present a case of non-obstetric vulvar hematoma that occurred after minimal trauma in a young, otherwise healthy woman who presented with labial swelling after consensual digital penetration, initially managed conservatively but ultimately requiring surgical drainage. Although a rare presentation in the emergency department, prompt identification, diagnosis, and management of vulvar hematoma is crucial to appropriately treat complications including pain, hemodynamically significant hemorrhage, urinary obstruction, and soft tissue necrosis.</p><p><strong>Topics: </strong>Vulvar hematoma, pelvic trauma, women's health, CT (computed tomography) angiography.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590978","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J88S81
Mary G McGoldrick, Laryssa Patti, Meigra Chin, Tiffany Murano
<p><strong>Audience: </strong>Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians.</p><p><strong>Introduction: </strong>Bite injuries and envenomation are core content found in the model of the clinical practice of emergency medicine.1 However, depending on the geographic location of training or clinical practice, physicians may or may not be exposed to these pathologies. For example, a qualitative analysis conducted in 2022 discovered a significant range in emergency medicine (EM) physician perception of snake antivenom use and level of comfort, noting that experiences with its use ranged from hundreds of cases treated to purely didactic understanding.2 Such discrepancies necessitate supplemental education and activities to bridge the knowledge gap. Ideally, these activities would utilize tenets of experiential learning to allow learner processing comparable to that of clinical experience.3 Flipped classroom and audience participation promote engagement and active learning when compared to the passive learning of lectures.4 In that vein, there is a growing body of gamified resources in medical education which utilize pattern recognition and problem solving skills that can be analogous to clinical practice.5,6.</p><p><strong>Educational objectives: </strong>By the end of this activity, learners will be able to: 1) identify and name species responsible for bite/sting/envenomation injuries, 2) recognize associated signs, symptoms, physical exam findings and complications associated with bites/stings/envenomations by certain species, 3) discuss management such as antibiotics, antivenom, and supportive care.</p><p><strong>Educational methods: </strong>We designed a small group activity asking residents to identify, research, and present the "culprits" implicated in environmental exposures to animals and insects, and match them to corresponding clinical scenarios.</p><p><strong>Research methods: </strong>Participants anonymously answered electronic multiple-choice quizzes before and after completing the activity to gauge its effectiveness in conveying the material. They also completed an additional anonymous, electronic survey regarding their attitudes towards this activity and the possibility of other gamified didactics within the curriculum.</p><p><strong>Results: </strong>Each resident class showed an upward trend in their average multiple-choice score, the greatest of which was seen in the post-graduate year (PGY) 1 class. The residency demonstrated a statistically significant improvement in their ability to answer multiple choice questions (MCQs), with an average pre-activity score of 67.14%, and post-activity score of 87.14%. Participants showed determination and enthusiasm to engage with the material when presented in a gamified format, and 100% of post-activity survey respondents wanted to participate in further gamified activities.</p><p><strong>Discussion: </strong>Gamified small group activities
{"title":"A Whodunit Gamified Flipped Classroom For High Yield Bite Injuries And Envenomation.","authors":"Mary G McGoldrick, Laryssa Patti, Meigra Chin, Tiffany Murano","doi":"10.21980/J88S81","DOIUrl":"10.21980/J88S81","url":null,"abstract":"<p><strong>Audience: </strong>Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians.</p><p><strong>Introduction: </strong>Bite injuries and envenomation are core content found in the model of the clinical practice of emergency medicine.1 However, depending on the geographic location of training or clinical practice, physicians may or may not be exposed to these pathologies. For example, a qualitative analysis conducted in 2022 discovered a significant range in emergency medicine (EM) physician perception of snake antivenom use and level of comfort, noting that experiences with its use ranged from hundreds of cases treated to purely didactic understanding.2 Such discrepancies necessitate supplemental education and activities to bridge the knowledge gap. Ideally, these activities would utilize tenets of experiential learning to allow learner processing comparable to that of clinical experience.3 Flipped classroom and audience participation promote engagement and active learning when compared to the passive learning of lectures.4 In that vein, there is a growing body of gamified resources in medical education which utilize pattern recognition and problem solving skills that can be analogous to clinical practice.5,6.</p><p><strong>Educational objectives: </strong>By the end of this activity, learners will be able to: 1) identify and name species responsible for bite/sting/envenomation injuries, 2) recognize associated signs, symptoms, physical exam findings and complications associated with bites/stings/envenomations by certain species, 3) discuss management such as antibiotics, antivenom, and supportive care.</p><p><strong>Educational methods: </strong>We designed a small group activity asking residents to identify, research, and present the \"culprits\" implicated in environmental exposures to animals and insects, and match them to corresponding clinical scenarios.</p><p><strong>Research methods: </strong>Participants anonymously answered electronic multiple-choice quizzes before and after completing the activity to gauge its effectiveness in conveying the material. They also completed an additional anonymous, electronic survey regarding their attitudes towards this activity and the possibility of other gamified didactics within the curriculum.</p><p><strong>Results: </strong>Each resident class showed an upward trend in their average multiple-choice score, the greatest of which was seen in the post-graduate year (PGY) 1 class. The residency demonstrated a statistically significant improvement in their ability to answer multiple choice questions (MCQs), with an average pre-activity score of 67.14%, and post-activity score of 87.14%. Participants showed determination and enthusiasm to engage with the material when presented in a gamified format, and 100% of post-activity survey respondents wanted to participate in further gamified activities.</p><p><strong>Discussion: </strong>Gamified small group activities ","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590773","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8RS8C
Ethan Hartman, Kimberly Sokol
<p><strong>Audience: </strong>Medical students, interns, junior resident physicians, senior resident physicians.</p><p><strong>Background: </strong>Power outages have been increasing in frequency in the past few years, therefore becoming an increased threat to healthcare delivery.1 While most studies related to the effects of power outages are focused on outpatient care, such as acute exacerbations of chronic lung conditions and the lack of chargeable equipment, with the increasing number of power outages, hospitals must be prepared for this situation as well.2,3 Although agencies such as the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) have provided guidelines for the response of hospitals to temporary loss of power,12,13 hospitals generally rely on institutional policies in response to the event of a power outage. Given the relative rarity but increasing frequency of power outages in hospital settings, this medical simulation was created to present a common occurrence in the emergency department (eg, cardiac arrest) in an uncommon setting of a power outage. Simulation has been shown to improve learner self-efficacy, confidence, and leadership skills among resuscitation teams.4,5 The role of simulation also helps learners identify latent safety threats, in this case a power outage.6 The goal of this simulation is to improve the skills of healthcare professionals with regards to managing cardiac arrest and to encourage these practitioners to consider their own hospital guidelines in response to a power outage.</p><p><strong>Educational objectives: </strong>By the end of this simulation, learners will be able to (1) evaluate and treat a patient experiencing myocardial infarction and subsequent cardiac arrest during a power outage, (2) describe the local protocols for managing patient care during a power outage, (3) demonstrate the ability to coordinate a medical team during a simulated power outage in an emergency department with limited resources, (4) manage a cardiac arrest patient by following Advanced Cardiac Life Support (ACLS) protocols for bradycardia and ventricular fibrillation, and (5) justify the urgency of transfer to a certified ST segment elevation myocardial infarction center/cardiac intensive care unit, referencing the recommended 120-minute door-to-balloon time.</p><p><strong>Educational methods: </strong>This simulation was conducted with a high-fidelity mannequin. A total of six residents of various post-graduate year (PGY) levels participated in the simulated patient encounter as part of the simulation competition at the Western Regional meeting of the Society for Academic Emergency Medicine.</p><p><strong>Research methods: </strong>This case was assessed for educational content and piloted by emergency medicine attendings from several institutions prior to running the case for the Western Regional meeting. The efficacy of the content was assessed by oral feedback.</p><p><s
{"title":"Going in Blind: A Common Scenario in an Uncommon Situation.","authors":"Ethan Hartman, Kimberly Sokol","doi":"10.21980/J8RS8C","DOIUrl":"10.21980/J8RS8C","url":null,"abstract":"<p><strong>Audience: </strong>Medical students, interns, junior resident physicians, senior resident physicians.</p><p><strong>Background: </strong>Power outages have been increasing in frequency in the past few years, therefore becoming an increased threat to healthcare delivery.1 While most studies related to the effects of power outages are focused on outpatient care, such as acute exacerbations of chronic lung conditions and the lack of chargeable equipment, with the increasing number of power outages, hospitals must be prepared for this situation as well.2,3 Although agencies such as the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) have provided guidelines for the response of hospitals to temporary loss of power,12,13 hospitals generally rely on institutional policies in response to the event of a power outage. Given the relative rarity but increasing frequency of power outages in hospital settings, this medical simulation was created to present a common occurrence in the emergency department (eg, cardiac arrest) in an uncommon setting of a power outage. Simulation has been shown to improve learner self-efficacy, confidence, and leadership skills among resuscitation teams.4,5 The role of simulation also helps learners identify latent safety threats, in this case a power outage.6 The goal of this simulation is to improve the skills of healthcare professionals with regards to managing cardiac arrest and to encourage these practitioners to consider their own hospital guidelines in response to a power outage.</p><p><strong>Educational objectives: </strong>By the end of this simulation, learners will be able to (1) evaluate and treat a patient experiencing myocardial infarction and subsequent cardiac arrest during a power outage, (2) describe the local protocols for managing patient care during a power outage, (3) demonstrate the ability to coordinate a medical team during a simulated power outage in an emergency department with limited resources, (4) manage a cardiac arrest patient by following Advanced Cardiac Life Support (ACLS) protocols for bradycardia and ventricular fibrillation, and (5) justify the urgency of transfer to a certified ST segment elevation myocardial infarction center/cardiac intensive care unit, referencing the recommended 120-minute door-to-balloon time.</p><p><strong>Educational methods: </strong>This simulation was conducted with a high-fidelity mannequin. A total of six residents of various post-graduate year (PGY) levels participated in the simulated patient encounter as part of the simulation competition at the Western Regional meeting of the Society for Academic Emergency Medicine.</p><p><strong>Research methods: </strong>This case was assessed for educational content and piloted by emergency medicine attendings from several institutions prior to running the case for the Western Regional meeting. The efficacy of the content was assessed by oral feedback.</p><p><s","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591061","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8N35D
Jessica Pelletier, Alexander Croft, Michael Pajor, Matthew Santos, Douglas Char, Marc Mendelsohn, Ernesto Romo
<p><strong>Audience: </strong>Emergency medicine (EM) residents. This simulation curriculum may also be utilized for senior medical students conducting EM rotations.</p><p><strong>Background: </strong>Ophthalmologic education represents only a small portion of medical school curriculums and continues to decrease over time, leaving physicians poorly equipped to diagnose and manage eye complaints.1 Of emergency physicians (EPs) surveyed, 72.5% felt that they could diagnose orbital compartment syndrome (OCS), yet only 40.3% felt comfortable performing a necessary lateral canthotomy and cantholysis (LCC).2 These survey results demonstrate the urgent need for improved ophthalmology education in EM residency to help us diagnose and manage potentially vision-threatening pathology.</p><p><strong>Educational objectives: </strong>By the end of this simulation, learners will be able to: 1) demonstrate the major components and a systematic approach to the emergency ophthalmologic examination, 2) develop a differential diagnosis of sight-threatening etiologies that could cause eye pain or vision loss, 3) demonstrate proficiency in performing potentially vision-saving procedures within the scope of EM practice.</p><p><strong>Educational methods: </strong>Low-fidelity simulation was conducted using a novel model adapted from that used by Phillips et al. during their ophthalmology day in the Department of Emergency Medicine at Vanderbilt University.3 The simulation case was developed by an interdepartmental team of ophthalmologists and EPs at our institution.</p><p><strong>Research objectives: </strong>To evaluate for statistically significant changes in self-efficacy, knowledge, and performance after an educational intervention. Our primary outcome was defined as a checklist-based performance on a simulated case of orbital compartment syndrome necessitating LCC.</p><p><strong>Research methods: </strong>We conducted a single-center prospective pre- and post-interventional study evaluating the impact of an educational intervention on EM resident management of a simulated case of OCS. Our two-part study intervention consisted of a lecture on OCS followed by a four and a half hour ophthalmology education day (OED). Residents were evaluated using self-efficacy scales (SES), multiple-choice questions (MCQ), and a performance checklist (developed via a modified Delphi process) at three timepoints: Pre-intervention, immediate post-intervention, and three months post-intervention. Post-graduate year (PGY)-1 through PGY-4 EM residents at an Urban Level 1 Trauma Center participated.</p><p><strong>Results: </strong>Initial recruitment consisted of 18 residents (PGY-1 through PGY-4), and 16 residents (PGY-1 through PGY-3) completed the study. Nine residents participated in the OED and seven residents did not. There were no pre-existing differences in median checklist-based performance, MCQ, or SES scores prior to the intervention. At three months post-OED, the OED attendees
{"title":"A Case of Painful Visual Loss - Managing Orbital Compartment Syndrome in the Emergency Department.","authors":"Jessica Pelletier, Alexander Croft, Michael Pajor, Matthew Santos, Douglas Char, Marc Mendelsohn, Ernesto Romo","doi":"10.21980/J8N35D","DOIUrl":"10.21980/J8N35D","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine (EM) residents. This simulation curriculum may also be utilized for senior medical students conducting EM rotations.</p><p><strong>Background: </strong>Ophthalmologic education represents only a small portion of medical school curriculums and continues to decrease over time, leaving physicians poorly equipped to diagnose and manage eye complaints.1 Of emergency physicians (EPs) surveyed, 72.5% felt that they could diagnose orbital compartment syndrome (OCS), yet only 40.3% felt comfortable performing a necessary lateral canthotomy and cantholysis (LCC).2 These survey results demonstrate the urgent need for improved ophthalmology education in EM residency to help us diagnose and manage potentially vision-threatening pathology.</p><p><strong>Educational objectives: </strong>By the end of this simulation, learners will be able to: 1) demonstrate the major components and a systematic approach to the emergency ophthalmologic examination, 2) develop a differential diagnosis of sight-threatening etiologies that could cause eye pain or vision loss, 3) demonstrate proficiency in performing potentially vision-saving procedures within the scope of EM practice.</p><p><strong>Educational methods: </strong>Low-fidelity simulation was conducted using a novel model adapted from that used by Phillips et al. during their ophthalmology day in the Department of Emergency Medicine at Vanderbilt University.3 The simulation case was developed by an interdepartmental team of ophthalmologists and EPs at our institution.</p><p><strong>Research objectives: </strong>To evaluate for statistically significant changes in self-efficacy, knowledge, and performance after an educational intervention. Our primary outcome was defined as a checklist-based performance on a simulated case of orbital compartment syndrome necessitating LCC.</p><p><strong>Research methods: </strong>We conducted a single-center prospective pre- and post-interventional study evaluating the impact of an educational intervention on EM resident management of a simulated case of OCS. Our two-part study intervention consisted of a lecture on OCS followed by a four and a half hour ophthalmology education day (OED). Residents were evaluated using self-efficacy scales (SES), multiple-choice questions (MCQ), and a performance checklist (developed via a modified Delphi process) at three timepoints: Pre-intervention, immediate post-intervention, and three months post-intervention. Post-graduate year (PGY)-1 through PGY-4 EM residents at an Urban Level 1 Trauma Center participated.</p><p><strong>Results: </strong>Initial recruitment consisted of 18 residents (PGY-1 through PGY-4), and 16 residents (PGY-1 through PGY-3) completed the study. Nine residents participated in the OED and seven residents did not. There were no pre-existing differences in median checklist-based performance, MCQ, or SES scores prior to the intervention. At three months post-OED, the OED attendees","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590695","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8WH2K
Adeola Adekunbi Kosoko, Alicia E Genisca, Nicholas A Peoples, Connor Tompkins, Ryan Sorensen, Joy Mackey
<p><strong>Audience and type of curriculum: </strong>This is a review curriculum utilizing multiple methods of education to enhance the skills of generalist healthcare providers in low- and middle-income countries (LMICs) in the identification and stabilization of pediatric respiratory emergencies. Our audience of implementation was Belizean generalist providers (nurses and physicians).</p><p><strong>Length of curriculum: </strong>8-10 hours.</p><p><strong>Introduction: </strong>Early recognition and stabilization of critical pediatric patients can improve outcomes. Compared with resource-rich systems, many low-resource settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. We created a curriculum for general practitioners comprising multiple educational modules focused on identifying and stabilizing pediatric emergencies. Our aim was to develop an educational framework to update and teach generalists on the recommendations and techniques of optimally evaluating and managing pediatric nutritional and gastrointestinal emergencies: bowel obstructions, gastroenteritis, and malnutrition.</p><p><strong>Educational goals: </strong>The aim of this curriculum is to increase learners' proficiency in identifying and stabilizing acutely ill pediatric patients with gastrointestinal medical or surgical disease or complications of malnutrition. This module focuses on the diagnosis and management of gastroenteritis, acute bowel obstruction, and deficiencies of feeding and nutrition. The target audience for this curriculum is generalist physicians and nurses in limited-resource settings.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum include didactic lectures, medical simulation, and small-group sessions.</p><p><strong>Research methods: </strong>We evaluated written pretests before and posttests after intervention and retested participants four months later to evaluate for knowledge retention. Participants provided qualitative feedback on the module.</p><p><strong>Results: </strong>We taught 21 providers. Eleven providers completed the pretest/posttest and eight completed the retest. The mean test scores improved from 8.3 ± 1.7 in the pretest to 12.2 ± 2.6 in the posttest (mean difference: 1.4, <i>P</i>=0.027). The mean test score at pretest was 8.3 ± 2.3, which increased to 10.8 ± 3.0 at retest (mean difference: 2.5, <i>P</i>=0.060). Seven (71.4%) and four (28.5%) participants found the course "extremely useful" and "very useful," respectively (n=11).</p><p><strong>Discussion: </strong>This curriculum may be an effective and welcome training tool for Belizean generalist providers. There was a statistically significant improvement in the test performance but not in retesting, possibly due to our small sample size and high attrition rate. Evaluation of other modules in this curriculum, application of this curriculum in other locations, and measuring clinical practice interventions will be i
{"title":"A Simulation and Small-Group Pediatric Emergency Medicine Course for Generalist Healthcare Providers: Gastrointestinal and Nutrition Emergencies.","authors":"Adeola Adekunbi Kosoko, Alicia E Genisca, Nicholas A Peoples, Connor Tompkins, Ryan Sorensen, Joy Mackey","doi":"10.21980/J8WH2K","DOIUrl":"10.21980/J8WH2K","url":null,"abstract":"<p><strong>Audience and type of curriculum: </strong>This is a review curriculum utilizing multiple methods of education to enhance the skills of generalist healthcare providers in low- and middle-income countries (LMICs) in the identification and stabilization of pediatric respiratory emergencies. Our audience of implementation was Belizean generalist providers (nurses and physicians).</p><p><strong>Length of curriculum: </strong>8-10 hours.</p><p><strong>Introduction: </strong>Early recognition and stabilization of critical pediatric patients can improve outcomes. Compared with resource-rich systems, many low-resource settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. We created a curriculum for general practitioners comprising multiple educational modules focused on identifying and stabilizing pediatric emergencies. Our aim was to develop an educational framework to update and teach generalists on the recommendations and techniques of optimally evaluating and managing pediatric nutritional and gastrointestinal emergencies: bowel obstructions, gastroenteritis, and malnutrition.</p><p><strong>Educational goals: </strong>The aim of this curriculum is to increase learners' proficiency in identifying and stabilizing acutely ill pediatric patients with gastrointestinal medical or surgical disease or complications of malnutrition. This module focuses on the diagnosis and management of gastroenteritis, acute bowel obstruction, and deficiencies of feeding and nutrition. The target audience for this curriculum is generalist physicians and nurses in limited-resource settings.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum include didactic lectures, medical simulation, and small-group sessions.</p><p><strong>Research methods: </strong>We evaluated written pretests before and posttests after intervention and retested participants four months later to evaluate for knowledge retention. Participants provided qualitative feedback on the module.</p><p><strong>Results: </strong>We taught 21 providers. Eleven providers completed the pretest/posttest and eight completed the retest. The mean test scores improved from 8.3 ± 1.7 in the pretest to 12.2 ± 2.6 in the posttest (mean difference: 1.4, <i>P</i>=0.027). The mean test score at pretest was 8.3 ± 2.3, which increased to 10.8 ± 3.0 at retest (mean difference: 2.5, <i>P</i>=0.060). Seven (71.4%) and four (28.5%) participants found the course \"extremely useful\" and \"very useful,\" respectively (n=11).</p><p><strong>Discussion: </strong>This curriculum may be an effective and welcome training tool for Belizean generalist providers. There was a statistically significant improvement in the test performance but not in retesting, possibly due to our small sample size and high attrition rate. Evaluation of other modules in this curriculum, application of this curriculum in other locations, and measuring clinical practice interventions will be i","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590757","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8CK98
Jodi DeJohn, Tania Ahluwalia, Manu Madhok, Shweta Gidwani, Katherine Douglass, Susan Owens
<p><strong>Audience: </strong>This is an in-person escape room and procedure simulation activity based on complications of human immunodeficiency virus (HIV) in India, which was created by using local HIV management guidelines. Emergency Medicine (EM) trainees of all post-graduate levels are the target audience. This may also be used by trainees in other specialties, such as infectious disease or internal medicine, who require an understanding of HIV and its complications. This escape room can be completed in teams of varying sizes and is designed to be adaptable to local resource availability.</p><p><strong>Background: </strong>Patients with HIV present to the Emergency Department (ED) for a variety of reasons such as initial viral syndrome, medication side effects, and opportunistic infections. While the widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of patients living with HIV and decreased the incidence of classical opportunistic infections, EM providers should still be vigilant and competent in diagnosing and managing these pathologies. This is particularly critical in India, where the prevalence of HIV was most recently estimated at 0.22% (2.2 million people older than 15 years) in 2020.1 This patient population, primarily infected through unprotected heterosexual contact, is at high risk for interruptions in ART and development of opportunistic infections for a variety of reasons including migration for work, low social status of women, and significant social stigma against HIV.2 Simulation is an educational opportunity to review these high-acuity low-occurrence presentations to prepare EM trainees for independent practice.</p><p><strong>Educational objectives: </strong>By the end of the escape room, learners should be able to: 1) describe the mechanism of action of antiretroviral therapies available in India, 2) prescribe initial antiretroviral therapy to a patient presenting to the emergency department with a new diagnosis of HIV, 3) develop a differential diagnosis for a patient with HIV presenting to the ED with chest pain, 4) identify common dermatologic manifestations of opportunistic infections in patients with HIV, 5) identify computerized tomography scan and lumbar puncture features for central nervous system infections seen in patients with Acquired Immunodeficiency Syndrome (AIDS), 6) identify red flag features and appropriate workup for a patient with HIV presenting with a headache to the ED, 7) interpret images obtained during a Rapid Ultrasound for Shock and Hemorrhage (RUSH) exam, 8) identify cardiac tamponade and perform a pericardiocentesis, and 9) communicate and collaborate as a team to manage a complex, unstable patient with HIV in the ED.</p><p><strong>Educational methods: </strong>We sought to create and implement an educational tool that could meet the complex education needs of EM trainees while being low cost, easily adapted to local resources, and engaging for traine
{"title":"Bridging Hospital Resource Variability: Adapting the Escape Room to Integrate Procedure Teaching for Emergency Medicine Trainees in India.","authors":"Jodi DeJohn, Tania Ahluwalia, Manu Madhok, Shweta Gidwani, Katherine Douglass, Susan Owens","doi":"10.21980/J8CK98","DOIUrl":"10.21980/J8CK98","url":null,"abstract":"<p><strong>Audience: </strong>This is an in-person escape room and procedure simulation activity based on complications of human immunodeficiency virus (HIV) in India, which was created by using local HIV management guidelines. Emergency Medicine (EM) trainees of all post-graduate levels are the target audience. This may also be used by trainees in other specialties, such as infectious disease or internal medicine, who require an understanding of HIV and its complications. This escape room can be completed in teams of varying sizes and is designed to be adaptable to local resource availability.</p><p><strong>Background: </strong>Patients with HIV present to the Emergency Department (ED) for a variety of reasons such as initial viral syndrome, medication side effects, and opportunistic infections. While the widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of patients living with HIV and decreased the incidence of classical opportunistic infections, EM providers should still be vigilant and competent in diagnosing and managing these pathologies. This is particularly critical in India, where the prevalence of HIV was most recently estimated at 0.22% (2.2 million people older than 15 years) in 2020.1 This patient population, primarily infected through unprotected heterosexual contact, is at high risk for interruptions in ART and development of opportunistic infections for a variety of reasons including migration for work, low social status of women, and significant social stigma against HIV.2 Simulation is an educational opportunity to review these high-acuity low-occurrence presentations to prepare EM trainees for independent practice.</p><p><strong>Educational objectives: </strong>By the end of the escape room, learners should be able to: 1) describe the mechanism of action of antiretroviral therapies available in India, 2) prescribe initial antiretroviral therapy to a patient presenting to the emergency department with a new diagnosis of HIV, 3) develop a differential diagnosis for a patient with HIV presenting to the ED with chest pain, 4) identify common dermatologic manifestations of opportunistic infections in patients with HIV, 5) identify computerized tomography scan and lumbar puncture features for central nervous system infections seen in patients with Acquired Immunodeficiency Syndrome (AIDS), 6) identify red flag features and appropriate workup for a patient with HIV presenting with a headache to the ED, 7) interpret images obtained during a Rapid Ultrasound for Shock and Hemorrhage (RUSH) exam, 8) identify cardiac tamponade and perform a pericardiocentesis, and 9) communicate and collaborate as a team to manage a complex, unstable patient with HIV in the ED.</p><p><strong>Educational methods: </strong>We sought to create and implement an educational tool that could meet the complex education needs of EM trainees while being low cost, easily adapted to local resources, and engaging for traine","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590897","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8H94V
Alice Walz, Ian Kane
<p><strong>Audience: </strong>The target audience for this small group workshop are interns and residents of any specialty.</p><p><strong>Introduction: </strong>All residents are expected to become proficient teachers in a variety of settings as they progress in training, and many residency programs offer advanced training or credentialing in medical education.1,2 Recently, some emergency medicine programs have also begun to offer a formal medical education fellowship. Traditional resident education has been in the form of didactic lectures such as morning report, noon conference, and Grand Rounds as well as small group bedside teaching by attendings. Due to the COVID-19 pandemic, in many cases these learning structures have been reengineered into a hybrid or virtual model.3 This new educational paradigm has spurred the search for best practice teaching methods across a variety of situations. 4 Active teaching, characterized by audience engagement and self-directed learning, has been shown to promote deeper understanding and improved knowledge retention when compared to standard didactic teaching.5,6Educational curricula for residents now acknowledge the importance of audience participation, with more emphasis on the use of interactive teaching techniques. A review of residents-as-teachers curricula highlighted the importance of disseminating practical resources for how to effectively teach residents to be better educators.7 However, in the literature there are few examples of how to teach residents to implement these best practice interactive teaching methods. We designed a simple, interactive, and easily reproducible workshop for introducing the concepts of active teaching to residents that allows for active engagement with these techniques.</p><p><strong>Educational objectives: </strong>By the end of this small group exercise, learners will be able to: 1) assess interactive teaching techniques that support learning in various environments; 2) incorporate active teaching techniques into a variety of real-world teaching scenarios; 3) implement selected techniques to enrich one's own teaching practice.</p><p><strong>Educational methods: </strong>Our workshop was designed to include elements of gamification, which facilitates teamwork and competition and can be used to engage learners in higher levels of learning.8 We began by performing a literature search for descriptions of active teaching techniques that had been used in the medical setting.9-14 We developed a list of 15 popular active teaching strategies and created a one-page menu which briefly described each strategy. Utilizing the flipped classroom model, we identified three articles (references 10, 11, and 14) which reviewed active teaching techniques and sent these articles to our participants via email one week before our session with instructions to read the articles and come prepared to discuss them at our session. We created two sets of playing cards for our activity. The first set o
{"title":"Actively Teaching Active Teaching Techniques.","authors":"Alice Walz, Ian Kane","doi":"10.21980/J8H94V","DOIUrl":"10.21980/J8H94V","url":null,"abstract":"<p><strong>Audience: </strong>The target audience for this small group workshop are interns and residents of any specialty.</p><p><strong>Introduction: </strong>All residents are expected to become proficient teachers in a variety of settings as they progress in training, and many residency programs offer advanced training or credentialing in medical education.1,2 Recently, some emergency medicine programs have also begun to offer a formal medical education fellowship. Traditional resident education has been in the form of didactic lectures such as morning report, noon conference, and Grand Rounds as well as small group bedside teaching by attendings. Due to the COVID-19 pandemic, in many cases these learning structures have been reengineered into a hybrid or virtual model.3 This new educational paradigm has spurred the search for best practice teaching methods across a variety of situations. 4 Active teaching, characterized by audience engagement and self-directed learning, has been shown to promote deeper understanding and improved knowledge retention when compared to standard didactic teaching.5,6Educational curricula for residents now acknowledge the importance of audience participation, with more emphasis on the use of interactive teaching techniques. A review of residents-as-teachers curricula highlighted the importance of disseminating practical resources for how to effectively teach residents to be better educators.7 However, in the literature there are few examples of how to teach residents to implement these best practice interactive teaching methods. We designed a simple, interactive, and easily reproducible workshop for introducing the concepts of active teaching to residents that allows for active engagement with these techniques.</p><p><strong>Educational objectives: </strong>By the end of this small group exercise, learners will be able to: 1) assess interactive teaching techniques that support learning in various environments; 2) incorporate active teaching techniques into a variety of real-world teaching scenarios; 3) implement selected techniques to enrich one's own teaching practice.</p><p><strong>Educational methods: </strong>Our workshop was designed to include elements of gamification, which facilitates teamwork and competition and can be used to engage learners in higher levels of learning.8 We began by performing a literature search for descriptions of active teaching techniques that had been used in the medical setting.9-14 We developed a list of 15 popular active teaching strategies and created a one-page menu which briefly described each strategy. Utilizing the flipped classroom model, we identified three articles (references 10, 11, and 14) which reviewed active teaching techniques and sent these articles to our participants via email one week before our session with instructions to read the articles and come prepared to discuss them at our session. We created two sets of playing cards for our activity. The first set o","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590896","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}
Pub Date : 2024-10-31eCollection Date: 2024-10-01DOI: 10.21980/J8506D
Rosalind Ma, Colin Danko
Early diagnosis of rheumatologic diseases can improve patient outcomes. While clinical presentations of rheumatologic diseases can be vague, dermatomyositis (DM) has distinctive cutaneous findings that can clue in providers towards the diagnosis. This is a case report of a 49-year-old female who presented with progressive facial swelling, rash, and generalized myalgias for a month. She had seen several outpatient providers and had one other emergency department (ED) visit for these symptoms prior to her diagnosis. She had already trialed steroid creams, antibiotics, and oral steroids with no significant improvement in her symptoms. A physical exam revealed peri-orbital edema, rash on her face, chest, and arms, and proximal muscle weakness. Lab work was significant for an elevated creatine kinase (CK). Rheumatology was consulted and recommended admission for expedited work-up for DM. The DM diagnosis was confirmed, and the patient was given intravenous immunoglobulin (IVIG) and discharged on oral steroids with dermatology and rheumatology outpatient follow-up. This case exemplifies how DM is often a missed diagnosis. However, by recognizing the classic dermatologic findings, conducting a muscle strength exam, and obtaining additional laboratory studies such as CK, the diagnosis can be made more easily.
{"title":"A Case Report on Dermatomyositis in a Female Patient with Facial Rash and Swelling.","authors":"Rosalind Ma, Colin Danko","doi":"10.21980/J8506D","DOIUrl":"10.21980/J8506D","url":null,"abstract":"<p><p>Early diagnosis of rheumatologic diseases can improve patient outcomes. While clinical presentations of rheumatologic diseases can be vague, dermatomyositis (DM) has distinctive cutaneous findings that can clue in providers towards the diagnosis. This is a case report of a 49-year-old female who presented with progressive facial swelling, rash, and generalized myalgias for a month. She had seen several outpatient providers and had one other emergency department (ED) visit for these symptoms prior to her diagnosis. She had already trialed steroid creams, antibiotics, and oral steroids with no significant improvement in her symptoms. A physical exam revealed peri-orbital edema, rash on her face, chest, and arms, and proximal muscle weakness. Lab work was significant for an elevated creatine kinase (CK). Rheumatology was consulted and recommended admission for expedited work-up for DM. The DM diagnosis was confirmed, and the patient was given intravenous immunoglobulin (IVIG) and discharged on oral steroids with dermatology and rheumatology outpatient follow-up. This case exemplifies how DM is often a missed diagnosis. However, by recognizing the classic dermatologic findings, conducting a muscle strength exam, and obtaining additional laboratory studies such as CK, the diagnosis can be made more easily.</p><p><strong>Topics: </strong>Dermatomyositis, weakness, rash, rheumatology, dermatology.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590713","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}
Pub Date : 2024-07-31eCollection Date: 2024-07-01DOI: 10.21980/J8293F
Claire A Grosgogeat, Kelly Medwid, Rami H Mahmoud, Brooke Hensley
Audience: This case was designed for emergency medicine interns and residents.
Introduction: Human trafficking is unfortunately an ever-growing and wide-reaching problem in the United States as well as the rest of the world. The International Labor Organization estimates 49.6 million people were affected by this modern-day slavery worldwide in 2021.1,2 The emergency department represents an opportunity to identify and provide aid to victims of human trafficking. Studies have shown that 63.3% of survivors interacted with the emergency department during their time of exploitation; however, most of these patients are not identified as human trafficking victims and opportunities for intervention are missed.3,4.
Educational objectives: By the end of this simulation, participants will be able to: (1) Identify signs of human trafficking. (2) Demonstrate the ability to perform a primary and secondary assessment of a patient when there is concern for human trafficking. (3) Demonstrate the ability to appropriately separate an at-risk patient from a potential trafficker. (4) Identify resources and a reliable course of action to permanently remove the patient from the harmful situation.
Educational methods: A hybrid teaching model was employed that included both a lecture and a standardized patient simulation session followed by a structured debriefing session.
Research methods: A simulation with a standardized participant was implemented at an urban academic emergency department with a three-year EM residency program. Participants were evaluated with a survey prior to and after the simulation, where they responded to questions regarding human trafficking patients on a scale of 1 to 5, where 5 represented the greatest level of agreement. Nineteen emergency medicine interns and residents participated in this project.
Results: Prior to simulation training, and after the lecture, residents were surveyed on their confidence in identifying and treating patients who are affected by trafficking, their level of previous training in this topic, and whether they considered trafficking an important issue in emergency medicine. When asked if human trafficking is an important issue faced by the emergency department, 15 of the 19 of residents who completed the survey rated the importance a 5/5 on a Likert scale ranging from 1-not important to 5. Residents were also asked if they had received prior training in human trafficking on a scale of never (1) to often (5). Eight residents responded with either never or close to never. Two months after the simulation, the residents were again sent an optional survey. Ten residents responded. All who participated in the simulation now rated themselves a 4/5 on a scale from not confident to very confident. Of those who did not attend the simulation, the median value was a 3/5. Out of the residents who
{"title":"Identification of a Human Trafficking Victim: A Simulation.","authors":"Claire A Grosgogeat, Kelly Medwid, Rami H Mahmoud, Brooke Hensley","doi":"10.21980/J8293F","DOIUrl":"10.21980/J8293F","url":null,"abstract":"<p><strong>Audience: </strong>This case was designed for emergency medicine interns and residents.</p><p><strong>Introduction: </strong>Human trafficking is unfortunately an ever-growing and wide-reaching problem in the United States as well as the rest of the world. The International Labor Organization estimates 49.6 million people were affected by this modern-day slavery worldwide in 2021.1,2 The emergency department represents an opportunity to identify and provide aid to victims of human trafficking. Studies have shown that 63.3% of survivors interacted with the emergency department during their time of exploitation; however, most of these patients are not identified as human trafficking victims and opportunities for intervention are missed.3,4.</p><p><strong>Educational objectives: </strong>By the end of this simulation, participants will be able to: (1) Identify signs of human trafficking. (2) Demonstrate the ability to perform a primary and secondary assessment of a patient when there is concern for human trafficking. (3) Demonstrate the ability to appropriately separate an at-risk patient from a potential trafficker. (4) Identify resources and a reliable course of action to permanently remove the patient from the harmful situation.</p><p><strong>Educational methods: </strong>A hybrid teaching model was employed that included both a lecture and a standardized patient simulation session followed by a structured debriefing session.</p><p><strong>Research methods: </strong>A simulation with a standardized participant was implemented at an urban academic emergency department with a three-year EM residency program. Participants were evaluated with a survey prior to and after the simulation, where they responded to questions regarding human trafficking patients on a scale of 1 to 5, where 5 represented the greatest level of agreement. Nineteen emergency medicine interns and residents participated in this project.</p><p><strong>Results: </strong>Prior to simulation training, and after the lecture, residents were surveyed on their confidence in identifying and treating patients who are affected by trafficking, their level of previous training in this topic, and whether they considered trafficking an important issue in emergency medicine. When asked if human trafficking is an important issue faced by the emergency department, 15 of the 19 of residents who completed the survey rated the importance a 5/5 on a Likert scale ranging from 1-not important to 5. Residents were also asked if they had received prior training in human trafficking on a scale of never (1) to often (5). Eight residents responded with either never or close to never. Two months after the simulation, the residents were again sent an optional survey. Ten residents responded. All who participated in the simulation now rated themselves a 4/5 on a scale from not confident to very confident. Of those who did not attend the simulation, the median value was a 3/5. Out of the residents who","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11312875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918262","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}
Pub Date : 2024-07-31eCollection Date: 2024-07-01DOI: 10.21980/J8P05P
Mahika Patlola, Aanchal A Shah, Thor S Stead, Latha Ganti
The authors present a case of symptomatic dermatographia. Dermatographia is an inducible urticaria where the light pressure of scratching leaves a raised wheal in the pattern of the scratching. The presentation can be striking and is often very stressful for the patient; however, the etiology is benign and the key takeaway is to provide reassurance to the patient.
{"title":"A Case Report of Dermatographia.","authors":"Mahika Patlola, Aanchal A Shah, Thor S Stead, Latha Ganti","doi":"10.21980/J8P05P","DOIUrl":"10.21980/J8P05P","url":null,"abstract":"<p><p>The authors present a case of symptomatic dermatographia. Dermatographia is an inducible urticaria where the light pressure of scratching leaves a raised wheal in the pattern of the scratching. The presentation can be striking and is often very stressful for the patient; however, the etiology is benign and the key takeaway is to provide reassurance to the patient.</p><p><strong>Topics: </strong>Dermatographia, urticaria, dermatology.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11312876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918256","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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