Acute patellar dislocation is a painful condition that can be effectively managed with prompt reduction. Successful reduction requires confidence, which comes with experience. Patellar dislocation is not prevalent enough for every emergency physician to encounter it in a live patient during residency training. Although the reduction maneuver is straightforward, trainees are often initially unsure of hand positioning and attempt to reduce the patella primarily with medial pressure. Simultaneous knee extension is an important component of the reduction, creating patellar and quadriceps tendon laxity and making for a smoother, less painful reduction. Many available videos demonstrate extension poorly and show the difficulty with which the reduction is performed when primarily medial patella pressure is used.1,2
The Covid-19 pandemic limited educational and career development opportunities for medical students, requiring innovative programs to accelerate professional identity formation and clinical skills acquisition.
The Accreditation Council for Graduate Medical Education (ACGME) requires programs to develop research curricula regarding how research is “conducted, evaluated, explained to patients, and applied to patient care.”1 Specific to fellowship, the ACGME requires fellows to participate in and complete scholarly work aligned with their subspecialty requirements.2 The American Board of Pediatrics (ABP) subspecialty in pediatric emergency medicine (PEM) further requires that each PEM fellow have a strong core knowledge in scholarly activities and complete meaningful scholarly work; the ABP tests research knowledge as part of the in-training exam (ITE), board certification exam, and maintenance of certification. The ITE and board exams’ proportion of research questions is not trivial (7% of questions overall).2,3
The Accreditation Council for Graduate Medical Education (ACGME) lists “educating patients, families, students, residents, and other health professionals” as a common core requirement for residency programs in every medical specialty.1 Residents often play a crucial role in peer and medical student education. Teaching others can solidify resident knowledge, enhance students’ knowledge, and influence career choices.2,3,4,5
The majority of pediatric visits occur in general emergency departments. Caring for critically ill neonates is a low-frequency but high-stakes event for emergency physicians, which requires specialized knowledge and hands-on training. We describe a novel clinical rotation for emergency medicine (EM) residents that specifically augments skills in neonatal resuscitation through direct participation as a member of the neonatal resuscitation team. The neonatal resuscitation rotation evaluation median score of 4 (interquartile range [IQR] 3,4) was higher compared to all other off-service senior resident rotations combined (median 3, IQR 3,4) for the academic year 2018–2019. Ninety-two percent of residents evaluated the curriculum change as beneficial (median 4, IQR 4,4). The neonatal resuscitation rotation was rated more favorably than the pediatric intensive care rotation (median 4 IQR 3,4 vs median 3, IQR 2, 3) at a tertiary care children’s hospital during the third year. Residency programs may want to consider implementing a directed neonatal resuscitation experience as part of a comprehensive pediatric curriculum for EM residents.
Emergency medicine residents are required to accurately log all procedures, yet it is estimated that many procedures are not logged. Traditional procedure logging platforms are often cumbersome and may contribute to procedures not being logged or being logged inaccurately. We designed a mobile procedure logging application (app) that uses quick response (QR) codes to input patient information quickly and accurately. The app integrates with our current procedure log database while maintaining information privacy standards. It scans the QR code displayed for patient identification, automatically extracting pertinent patient information. The user selects the procedure performed and the app uses data analytics to recommend logging other related procedures.
To successfully provide effective patient care within a healthcare system and broader society facing health inequities and social injustice, emergency medicine (EM) residents must demonstrate a nuanced understanding of social determinants of health (SDOH). Classroom or bedside instruction may be insufficient to generate meaningful engagement with patients’ social contexts; experiential collaborative learning with community engagement has been suggested as an ideal modality for education about SDOH. We describe a low-cost, easily replicable activity involving observation and discussion of community murals within built environments. The tour was planned by EM faculty with expertise in graduate medical education, social EM, and the use of art in medical education. Prior to the activity, faculty selected murals situated in a variety of neighborhoods that would spark discussion on SDOH. Over the two-hour tour, residents stopped at city murals on a pre-planned route and engaged in observation and discussion. Faculty facilitators used established arts pedagogy, including visual thinking strategies and the concept of the “third thing,” to facilitate a collaborative exploration of murals, surrounding communities, and larger implications for patients. The activity was successful in providing residents with a nuanced, context-specific approach to SDOH, sparking greater curiosity about the communities they serve, and engaging residents in reflection and conversation about personal preconceptions and how to better engage with surrounding communities. Since murals and street art are present and accessible in many different settings, residency programs could consider implementing a similar activity as part of their didactic curriculum.
Physician assistants (PA) are an important part of emergency department healthcare delivery and are increasingly seeking specialty-specific postgraduate training. Our goal was to pilot the implementation of a PA postgraduate program within an existing physician residency program and produce emergency medicine-PA (EM-PA) graduates of comparable skill to their physician counterparts who have received the equivalent length of EM residency training to date (evaluated at the end of first year of EM training).
Racism impacts patient care and clinical training in emergency medicine (EM), but dedicated racism training is not required in graduate medical education. We designed an innovative health equity retreat to teach EM residents about forms of racism and skills for responding to racial inequities in clinical environments. The three-hour retreat occurred during the residency didactic conference to maximize resident participation. We prioritized facilitated reflection on residents’ own experiences of race and racism in medicine in order to emphasize these concepts’ relevance to all participants. We used workshop, small group, and panel formats to optimize interactivity and discussion. Post-retreat survey respondents indicated that the curriculum successfully promoted awareness of racism in the workplace. Participants also expressed interest in continued discussions about racism in medicine as well as desire for greater faculty and nursing participation in the curriculum. Residency programs should consider incorporating similar educational sessions in core didactic curricula.
Medical students transition to intern year with significant variability in prior clinical experience depending on their medical school education. This leads to notable differences in the interns’ ability to perform focused histories and physical exams, develop reasoned differentials, and maximize care plans. Providing a foundational experience for these essential skills will help to establish standardized expectations despite variable medical school experiences.
The development of clinical reasoning abilities is a core competency of emergency medicine (EM) resident education and has historically been accomplished through case conferences and clinical learning. The advent of the SARS-CoV-2 pandemic has fundamentally changed these traditional learning opportunities by causing a nationwide reliance on virtual education environments and reducing the clinical diversity of cases encountered by EM trainees.
We propose an innovative exercise that allows trainees to explore implicit bias outside of the clinical environment, in an interdisciplinary manner with museum anthropologists and archaeologists. The curriculum was designed with leaders at the Penn Museum and focuses on differentiating between objective and subjective assessments of historical objects.
This journal club style curriculum was developed to advance 4th year medical students in Emergency Medicine (EM) Milestone 19. The curriculum was introduced as part of a longitudinal boot camp course for EM- bound students.
Gender disparities exist in academic emergency medicine (EM). We developed and implemented a female EM physician group – Women in Academic Emergency Medicine (WAM) – to support female EM residents, fellows, and faculty.
We developed a multi-modal, learner-driven, interactive curriculum to address the unique nonclinical challenges senior EM residents face during the transition from residency to independent practice.
It has been a challenge to assess communication and professional values Milestones in emergency medicine (EM) residents using standardized methods, as mandated by the Accreditation Council for Graduate Medical Education (ACGME). This paper outlines an innovative method of assessing these Milestones using an established instructional method.
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.
The objectives for this educational innovation were to 1) implement a team-based model of a M4 student clinical experience; 2) measure the student’s clinical performance from their end-of-shift evaluations and case logs; and 3) assess the perception of the model from faculty and students.
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.
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.
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.
The best use of survey methodology is to investigate human phenomena, such as emotions and opinions. These are data that are neither directly observable, nor available in documents. Moreover, a new survey instrument is only indicated when a prior instrument does not exist or is determined empirically to have insufficient validity and reliability evidence for the sampling frame of interest.
In 1990, Ernest Boyer called on academic medicine to affirm its central role in education by expanding the scope of scholarship to include the domain of teaching.
Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback.
