Articles

Do End-of-Rotation and End-of-Shift Assessments Inform Clinical Competency Committees’ (CCC) Decisions?

Regan, MD, et al.

The residency program is an urban academic four-year emergency medicine residency with 48 residents. After their shifts in the emergency department (ED), residents handed out EOS assessment forms asking about individual milestones from 15 subcompetencies to supervising physicians, as well as triggered electronic EOR-doctor (EORd) assessments to supervising doctors and EOR-nurse (EORn) to nurses they had worked with after each two-week ED block.

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Experience Within the Emergency Department and Improved Productivity for First-Year Residents in Emergency Medicine and Other Specialties

Joseph, MD, MS, et al.

This was a retrospective cohort study, conducted in an urban academic hospital ED, with a three-year EM training program in which first-year residents see new patients ad l
ibitum. We evaluated resident shifts for the total number of new patients seen. We constructed a generalized estimating equation to predict productivity, defined as the number of new patients seen per shift, as a function of the week of the academic year, the number of weeks spent in the ED, and their interaction. Off-service residents’ productivity in the ED was analyzed in a secondary analysis.

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Emergency Medicine Student End-of-Rotation Examinations: Where Are We Now?

Miller, MD, et al.

This review is a descriptive summary of the development of these examinations and their relevant usage and performance data. In particular, we describe how examination content was edited to affect desired changes in examination performance data and offer a model for educators seeking to develop their own examinations.

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Development of a Case-based Reading Curriculum and Its Effect on Resident Reading

Messman, MD, et al.

Textbook reading plays a foundational role in a resident’s knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum.

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Free Open Access Medical Education (FOAM) Resources in a Team-Based Learning Educational Series

Fallon, MD, et al.

We sought to develop an educational intervention whereby residents could review FOAM resources while maintaining faculty oversight. We created a novel curriculum pairing FOAM from the Academic Life in Emergence Medicine (ALiEM) Approved Instructional Resources (Air) series with a team-based learning (TBL) format. Residents have an opportunity to engage with FOAM in a structured setting with faculty input on possible practice changes. This series has been well-received by residents and appears to have increased engagement with core content material.

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Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation

Barrie, MD, et al.

Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format.

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Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department

Manning, BS, et al.

We set out to determine the feasibility of using third-year medical students’ action learning projects (QI projects) to expedite implementation of evidence-based pathways for three common patient diagnoses in the ED setting as well as develop a model for promoting bidirectional alignment at an institutional level. We further evaluated clinician perspectives on using medical students at the forefront of QI pathway development.

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Exploratory Application of Augmented Reality/Mixed Reality Devices for Acute Care Procedure Training

Kobayashi, MD, et al.

Investigators initiated an exploratory program to enable the study of AR/MR use-cases in acute care clinical and instructional settings. Investigators implemented a core holoimaging pipeline infrastructure and modular open-access repository to generate and enable access to modular holoimages during exploratory pilot stage applications for invasive procedure training that featured innovative AR/MR techniques on off-the-shelf headset devices.

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Creating a Vision for Education Leadership

Martin, MD, MBA, et al.

This brief innovative report will provide tools and examples to articulate a vision statement for education leadership and the steps needed for implementation. The objective of this innovation is for the readers to develop their own vision, mission and core values, and to begin to consider how they will develop their strategy and platform for implementation. While these VMCV may be aligned with your organization’s VMCV, it is important to define your own. Examples of VMCV from education leaders will be presented. This concept is based on a workshop from the Society for Academic Emergency Medicine (SAEM) in 2017 that was developed by key education leaders in the field of EM.

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Calling All Curators: A Novel Approach to Individualized Interactive Instruction

Pensa, MD, et al.

We describe a digital course in EM, “Asynchrony,” as an approach to FOAM to meet these III standards. Asynchrony is geared toward EM residents using FOAM and other online learning tools, curated by faculty into narrative, topic-specific educational modules. Each module requires residents to complete a topic assignment, participate in a discussion board, and pass a quiz to earn ACGME-approved III didactic credit; all of this is tracked and filed in an online learning management system.

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Development of a Novel Ultrasound-guided Peritonsillar Abscess Model for Simulation Training

Ng, MD, MPH, et al.

Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck presenting to emergency departments.1 No commercial PTA task trainer exists for simulation training. Thus, resident physicians often perform their first PTA needle aspiration in the clinical setting, knowing that carotid artery puncture and hemorrhage are serious and devastating complications. While several low-fidelity PTA task trainers have been previously described, none allow for ultrasound image acquisition.6–9 We sought to create a cost-effective and realistic task trainer that allows trainees to acquire both diagnostic ultrasound and needle aspiration skills while draining a peritonsillar abscess.

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Anything but Shadowing! Early Clinical Reasoning in Emergency Department Improves Clinical Skills

Royan, MPH, et al.

Transitioning from the pre-clinical environment to clerkships poses a challenge to students and educators alike. Students along with faculty developed the Clinical Reasoning Elective (CRE) to provide pre-clinical students exposure to patients in the emergency department and the opportunity to build illness scripts and practice clinical skills with longitudinal mentorship in a low-stakes environment before entering clerkships. It is a voluntary program. Each year, the CRE has received overwhelming positive feedback from students. The objective of this study is to determine if the CRE improved students’ clinical skills and reported comfort in their skills.

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Interprofessional Emergency Training Leads to Changes in the Workplace

Eisenmann, MD, et al.

Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care. The objective was to sensitize participants to barriers for their team skills and communication across professional borders.

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A Novel Approach to Medical Student Peer-assisted Learning Through Case-based Simulations

Jauregui, MD, et al.

Peer-assisted learning (PAL) is the development of new knowledge and skills through active learning support from peers. Benefits of PAL include introduction of teaching skills for students, creation of a safe learning environment, and efficient use of faculty time. We present a novel approach to PAL in an emergency medicine (EM) clerkship curriculum using an inexpensive, tablet-based app for students to cooperatively present and perform low-fidelity, case-based simulations that promotes accountability for student learning, fosters teaching skills, and economizes faculty presence.

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A Cognitive Apprenticeship-Based Faculty Development Intervention for Emergency Medicine Educators

Merritt, MD, MPH, et al.

Emergency medicine (EM) trainees must achieve expertise across the broad spectrum of clinical skills critical to EM practice, achieving competence in only a few short years. While EM training includes didactics, self-directed learning, and periodic assessments, the key learning occurs while caring for patients under the supervision of experienced physicians. While early medical education often focuses on transmission and retention of data, learners must ultimately gain practical experience applying clinical reasoning, learning to work in teams, and approaching complicated problems and procedures. The understanding and strategic implementation of problem-solving strategies, heuristic approaches, and metacognitive skills leads to the type of understanding that allows the novice to become the expert.

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Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

Parsons, MD, et al.

In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.

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Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

Carmen N. Spalding, PhD, et al.

Emergency Medicine (EM) is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME) during residency. Training and practicing key elements of DME using standardized patients (SP) may enhance preparedness among EM residents in performing this crucial skill in a clinical setting.

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Impact Factor for WestJEM

Langdorf, MD.

I want to take this opportunity to update our readers, reviewers, and supporters regarding the growth and stature of the Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health (WestJEM). We continue to grow and thrive, extending our scope and reach throughout the nation and the world.

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Emergency Department Operations

Decreasing Emergency Department Walkout Rate and Boarding Hours by Improving Inpatient Length of Stay

Artenstein, MD, et al.

Patient progress, the movement of patients through a hospital system from admission to discharge, is a foundational component of operational effectiveness in healthcare institutions. Optimal patient progress is a key to delivering safe, high-quality and high-value clinical care. The Baystate Patient Progress Initiative (BPPI), a cross-disciplinary, multifaceted quality and process improvement project, was launched on March 1, 2014, with the primary goal of optimizing patient progress for adult patients.

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Endemic Infections

Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers

Koenig, MD, et al.

Infection with hepatitis A virus (HAV) causes a highly contagious illness that can lead to serious morbidity and occasional mortality. Although the overall incidence of HAV has been declining since the introduction of the HAV vaccine, there have been an increasing number of outbreaks within the United States and elsewhere between 2016 and 2017.

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Societal Impact on Emergency Care

Why Emergency Physicians Should Care About the Salton Sea

Marshall, MD.

Currently, emergency departments in Imperial County treat three times more pediatric asthma visits than elsewhere in California.5,6 Recently, there has been new governmental, academic, and community interest in this issue, and as emergency physicians we have a unique opportunity to become involved in the health of the Salton Sea as well as the surrounding community.

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Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

Hsia, MD, et al.

California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends.

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Poor Access for African Researchers to African Emergency Care Publications: A Cross-sectional Study

Bruijns, MBChB, et al.

Based on relative population size and burden of disease, emergency care publication outputs from low- and middle-income regions are disproportionately lower than those of high-income regions. The aim of this study was to describe access to African emergency care publications in terms of publisher-based access (open access or subscription) and alternate access (self-archived or author provided), as well as the cost of access.

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Critical Care

Team Size and Stretching-Exercise Effects on Simulated Chest Compression Performance and Exertion

Schoen, MD, et al.

Investigators conducted a prospective experimental study to evaluate the effect of team size and recovery exercises on individual providers’ compression quality and exertion. Investigators hypothesized that 1) larger teams would perform higher quality compressions with less exertion per provider when compared to smaller teams; and 2) brief stretching and breathing exercises during rest periods would sustain compressor performance and mitigate fatigue.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.