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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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Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education

Volume 17, Issue 3, May 2016
Ryan Miller, BS et al.

Introduction: Over the past decade, medical students have witnessed a decline in the
opportunities to perform technical skills during their clinical years. Ultrasound-guided central
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venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine,
anesthesia, and general surgery residents, often during their first month of residency. However, the
acquisition of skills required to safely perform this procedure is often deficient upon graduation from
medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have
been introduced into undergraduate medical education to train venous access skills. Criticisms of
simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical
variances when compared to living patients. The purpose of our investigation was to design and
evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver.
Methods: This was a cross-sectional study at an urban academic medical center. An 18-point
procedural knowledge tool and an 18-point procedural skill evaluation tool were administered
during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver
lab, procedure naïve third-year medical students were trained on how to perform ultrasoundguided
central venous access of the femoral and internal jugular vessels. Preparation of the fresh
cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the
femoral and internal jugular vein respectively.
Results: Fifty-six third-year medical students participated in this study during their surgical
clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite
numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12
(p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001).
Conclusion: The use of this novel cadaver model prevented extravasation of fluid, maintained
ultrasound-imaging quality, and proved to be an effective educational model allowing third-year
medical students to improve and maintain their technical skills.

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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.