setup-execution-rapid-cycle-deliberate-practice-death-notification

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...

Does buffered lidocaine decrease the pain of local infiltration?

Is adjunctive dexamethasone beneficial in patients with bacterial meningitis?

Does this patient with minor head trauma need neuroimaging?

Fresh human cadavers provide an effective model for procedural training. Currently, there are no realistic models to teach fascial compartment pressure measurement.

A human cadaver fascial compartment pressure measurement model.

Should children with acute asthma exacerbation receive inhaled anticholinergics?

In reply.

Does Colchicine Improve Pain in an Acute Gout Flare?

Do α-Blockers Expedite Ureteral Stone Passage?

Should I Use Lidocaine With Epinephrine in Digital Nerve Blocks?

There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack-Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack-Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position.

Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions.

Feasibility of  upright patient positioning and intubation success rates At two academic EDs.

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

Changing Systems Through Effective Teams: A Role for Simulation.

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change. Implementing HF in EM through health care simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between HF professionals and EM, such as in this breakout group.

Human Factors and Simulation in Emergency Medicine.

The aims of this study were to identify the needs for further critical care experience for pediatric and internal medicine-pediatric residents, to describe a multidisciplinary approach to education, and to assess the impact of high-fidelity simulation on critical care comfort and perceived competence in pediatric residents. In addition, this study assessed pediatric residents' attitudes toward simulation as a means of providing additional education with critically ill patients.

Use of Simulation to Improve the Comfort of Pediatric Residents Managing Critically Ill Emergency Department Patients.

The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.

Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program.

Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations.

Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

Background One of the key components of residency training is to become an educator. Resident physicians teach students, advanced practice providers, nurses, and even faculty on a daily basis. Objective The goal of this study was to identify the objective characteristics of residents, which correlate with perceived overall teaching effectiveness. Methods We conducted a one-year, retrospective study to identify factors that were associated with higher resident teaching evaluations. Senior emergency medicine (EM) teaching residents are evaluated by medical students following clinical teaching shifts. Eighteen factors pertaining to resident teaching effectiveness were chosen. Two items from the medical students' evaluations were analyzed against each factor: teaching effectiveness was measured on a five-point Likert scale and an overall teaching score (1-75). Results A total of 46 EM residents and 843 medical student evaluations were analyzed. The ACGME milestones for systems-based practice ( = 0.02) and accountability ( = 0.05) showed a statistically significant association with a rating of "five" on the Likert scale for teaching effectiveness. Three other ACGME milestones, systems-based practice ( = 0.01), task switching ( = 0.04), and team management ( = 0.03) also showed a statically significant association of receiving a score of 70 or greater on the overall teaching score. Conclusion Residents with higher performance associated with system management and accountability were perceived as highly effective teachers. USMLE and in-service exams were not predictive of higher teaching evaluations. Our data also suggest that effective teachers are working in both academic and community settings, providing a potential resource to academic departments and institutions.

Factors that Contribute to Resident Teaching Effectiveness.

Death notification can be challenging for emergency medicine physicians, who have no prior established relationship with the patient or their families. The GRIEV_ING death notification curriculum was developed to facilitate the delivery of the bad news of a patient's death and has been shown to improve learners' confidence and competence in death notification. Rapid-cycle deliberate practice (RCDP), a facilitator-guided, within-event debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment. The aim of this study was to identify whether the use of this technique is an effective method of teaching the GRIEV_ING curriculum, as demonstrated by learners' improved confidence, cognitive knowledge and performance. Rapid-cycle deliberate practice (RCDP), a facilitator-guided within-event, debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment METHODS: A 4-hour pilot curriculum was developed to educate and assess residents on the delivery of death notification. The curriculum consisted of a pre-intervention evaluation, the intervention phase, and a post-intervention evaluation. The cognitive test, critical action checklist, and self-efficacy/confidence surveys were identical for both pre- and post-intervention evaluations. A Wilcoxon rank-sum test was used to evaluate differences in scores between pre- and post-intervention groups.

Rapid-cycle deliberate practice: death notification.

High-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment.

Article	Year
Does buffered lidocaine decrease the pain of local infiltration? Annals of emergency medicine\| PubMed ID: 21820761	2012
Is adjunctive dexamethasone beneficial in patients with bacterial meningitis? Annals of emergency medicine\| PubMed ID: 22088494	2012
Does this patient with minor head trauma need neuroimaging? Annals of emergency medicine\| PubMed ID: 22387084	2012
A human cadaver fascial compartment pressure measurement model. The Journal of emergency medicine\| PubMed ID: 23845521	2013
Should children with acute asthma exacerbation receive inhaled anticholinergics? Annals of emergency medicine\| PubMed ID: 25017823	2015
In reply. Annals of emergency medicine\| PubMed ID: 25454571	2014
Does Colchicine Improve Pain in an Acute Gout Flare? Annals of emergency medicine\| PubMed ID: 25920385	2015
Do α-Blockers Expedite Ureteral Stone Passage? Annals of emergency medicine\| PubMed ID: 26116222	2016
Should I Use Lidocaine With Epinephrine in Digital Nerve Blocks? Annals of emergency medicine\| PubMed ID: 27125816	2016
Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position. Internal and emergency medicine\| PubMed ID: 27300036	2017
Feasibility of upright patient positioning and intubation success rates At two academic EDs. The American journal of emergency medicine\| PubMed ID: 28202295	2017
Changing Systems Through Effective Teams: A Role for Simulation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine\| PubMed ID: 28727258	2018
Human Factors and Simulation in Emergency Medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine\| PubMed ID: 28925571	2018
Use of Simulation to Improve the Comfort of Pediatric Residents Managing Critically Ill Emergency Department Patients. Pediatric emergency care\| PubMed ID: 30180098	2018
Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program. Pediatric emergency care\| PubMed ID: 30870337	2019
Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation. Cureus\| PubMed ID: 31057999	2019
Factors that Contribute to Resident Teaching Effectiveness. Cureus\| PubMed ID: 31183271	2019
Rapid-cycle deliberate practice: death notification. The clinical teacher\| PubMed ID: 32472732	2020
Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal. MedEdPORTAL : the journal of teaching and learning resources\| PubMed ID: 32704538	2020

Dylan Cooper

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