Research Forum Abstracts
Bhv 2006). The job search assistance curriculum would address this issue by
providing structured education and building self-efficacy.
Objectives: To develop a multi-modal and portable job search curriculum based
on adult learning theories. To improve emergency medicine residents’ knowledge,
skills and attitudes regarding job search behaviors.
Methods: The program comprises a series of 6 one-hour sessions with the senior
emergency medicine residents at Maimonides Medical Center, delivered during
weekly conference from 7/1/12-9/1/12. The major topics covered by the curriculum
will include: 1) Practice Groups, 2) Job Contracts, 3) Curriculum Vitae, 4) Letters of
Recommendation, 5) Interviewing skills and 6) Budgeting and timelines. The
instructional methods are multimodal and include personal pre-reading, small group
sessions, workshops, mock interviews and expert panels. Throughout the curriculum,
the residents will create and maintain a worksheet gauging progress toward their
goals, building self-efficacy. This curriculum employs constructivist and realist
methods of research including just-in-time teaching, scaffolding, active learner
experimentation, and design-redesign iterations.
Results: Resident evaluation will be formative and summative, and will be
triangulated with observation, written assignments and questionnaires. Residents and
faculty will also complete evaluations of the curriculum. Residents who graduated
prior to the curriculum induction will be surveyed as a control group. The curriculum
will undergo design-redesign iterations based on evaluation results.
Conclusion: The intricacies of job search behaviors are important for residents to
learn, but are not taught consistently. The proposed curriculum is designed to
improve knowledge, skills and attitudes regarding job search behaviors with the
ultimate goal of increasing self-efficacy for residents’ future experiences. The
curriculum can be adjusted and adapted to other programs and specialties.
TF-14 Unique Challenges and Patient Management in
a Rural Emergency Department
Marshall TC/West Virginia University, Morgantown, WV
Introduction: Residents are typically trained in large hospitals with readily
available specialty and subspecialty care. After graduation (or while moonlighting),
many will work in small, rural hospitals with limited resources and specialties. The
goal of this instructional module is to prepare resident physicians for the unique
challenges encountered in a small, rural emergency department (ED). Learners will be
primarily resident physicians trained in a large, tertiary care referral center with
minimal exposure to the daily challenges and difficulties encountered when practicing
in a small, rural ED. Attending physicians, medical students, midlevel providers,
nurses, and techs may also find this useful and are encouraged to participate in the
discussion/simulation in their defined roles.
Objectives:
1. Recognize unique challenges and management difficulties encountered in a
rural ED
2. Recognize that all types of patients present to all types of EDs
3. Incorporate didactic learning into rural emergency medicine practice
4. Incorporate lessons learned/practice managing critically ill patients in a rural
ED environment with limited resources/staffing
5. Recognition of critically ill patients/conditions that must be stabilized prior to
transfer for definitive care and facilitate patient transfer
Methods: Instruction will take place over a period of 3-4 hours, utilizing one day
of didactic sessions. The first hour will be a short introductory lecture about the
unique challenges and difficulties faced when working in an isolated rural ED,
followed by a small group discussion with a panel of practicing rural emergency
physicians regarding their experiences. The final phase of the module will be 2-3
hours of simulation training in our simulation center. The learners will work through
4 cases with unique challenges and limited resources that are often not encountered in
a large referral center or community hospital. This will be followed by a debriefing
session with discussion of the cases and the clinical challenges involved in managing
them in this type of setting. Evaluation will involve scoring the learners on their
performance of certain “critical actions” and realtime feedback will be given during
the debriefing discussion by practicing rural emergency physicans and attending
physicians in the Department of Emergency Medicine at WVU.
Conclusion: Most residents train in large hospitals with many resources and
consulting services available at their fingertips. Many will work in rural settings where
these are limited. The goal of this module is to help prepare residents for some of the
unique challenges and management difficulties that they will encounter in this
environment; thus, allowing them to have more confidence and an increased
knowledge base regarding these often difficult clinical encounters.
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TF-15 Peer Chart Review for Observation Medicine
Patients With Chest Pain as a Novel Teaching
Tool
Osborne AD, Leach G, O’Malley RE, Ross MA, Wheatley M/Emory University,
Atlanta, GA
Introduction: Observation medicine is a fast-growing portion of emergency
medicine. Much of the low risk chest pain population is treated in an emergency
department administered unit as part of an accelerated diagnostic protocol.
Additionally, acute coronary syndromes (ACS) is rapidly becoming a major part of
emergency department care. The goal of the educational project was to create a
sustainable tool and method for teaching residents principles of observation medicine
care and stress test selection. The target audience is 2nd year residents on their
observation medicine rotation. This continues our ongoing advances in observation
medicine education.
Objectives: To provide a chart review tool that would allow residents to apply
evidence-based medicine about the principles of observation medicine to real patients
and further to provide them with feedback about their patients in an objective, non-
confrontational manner.
Methods: PGY -2 emergency medicine residents use an HTML-based tool
(hereafter referred to as the “worksheet”) to determine if patients are appropriate
candidates for the ED observation unit (EDOU) and what the optimal stress test
would have been for their EDOU chest pain protocol. Included on the worksheet
are general exclusion parameters, stress test selection criteria and 10 sequential
chest pain patients from random providers who were placed in the EDOU. These
patients are 1-2 months removed from their EDOU stay. There is a risk
stratification diagram available on worksheet. Each link, when selected goes to a
partially pre-populated Web site form. This form has several questions related to
the date of service and provider listed as well as space for outcome. The resident
is expected to separately open the electronic medical record and fill out the form
with questions presented. On the form, there is an additional question
incorporating the North American Chest Pain Rule. The residents apply their
interpretation of the actual clinical scenario to this rule, the Reilly-Goldman risk
stratification rule and to the general principles of observation medicine
management about patient selection displayed on the worksheet and the form.
Their responses populate a secure database and will also later be provided to
residents who care for the patients as objective feedback about testing outcome
and return visit. The tool and process obtains feedback from residents completing
rotation on a standard data collection tool. Evaluation of the tool will be
aggregated from the residents over their remaining years in residency. The
aggregate measures are discharge rate for the unit, patient appropriateness based
on the tool data, and resident feedback at residency completion. Preliminary
patient appropriateness rate as evaluated by residents is 75% which will be used
as initial data point.
Conclusion: The Web-based tool and learning modules are functional and
simple to use according to resident feedback. During the development and pilot
stage, the initial feedback has been positive. This tool allows us to teach
observation medicine principles in real clinical scenarios as well as the principles
of administrative chart review. More longitudinal data will be necessary to
observe if this additionally changes the practice of providers and to develop a
coefficient of variance. Also, additional administrators will have to be trained to
make this program more sustainable.
TF-16 Project Professionalism
Slick J/LSU Health Sciences Center, New Orleans, LA
Introduction: The core competencies of professionalism and interpersonal and
communication skills (PICS) have proven the most difficult to teach, measure and
evaluate. Despite guidelines that we have in our existing toolbox, education of
emergency medicine residents and students in these areas remains challenging and
nebulous. Residents not adequately trained in PICS may be unprepared and may
perform poorly on patient satisfaction surveys (PSS) when starting their emergency
medicine careers.
The education of PICS is a difficult task. Just the mention of these topics is
enough to prompt a deep sigh and eye rolling response from many of our learners.
Project Professionalism (PP) is a “resident-friendly and resident-approved”
curriculum. It has been developed with significant resident input and participation.
Resident volunteers were solicited through e-mail, with all interested respondents
welcomed to participate. Representatives from all PGY levels are included. Residents
Annals of Emergency Medicine S161
Research Forum Abstracts
participated in selection of topics, and development and delivery of workshops. The
primary audience for this curriculum is emergency medicine residents. Medical
students and off-service residents rotating through the ED will be a secondary
audience for some aspects of the training.
Objectives: To provide emergency medicine learners with PICS training with 3
primary goals in mind: 1) to improve communication with patients and their
families, 2) to improve interactions and professional relationships with colleagues
from other services, 3) to prepare residents for high achievement on measures of
PICS, particularly PSS.
Methods: This is a series of lectures, small group and role-playing exercises. The
modules will be presented in a longitudinal fashion throughout the 4 years of
residency. Each PGY level will receive one hour of focused instruction pertinent to
S162 Annals of Emergency Medicine
their roles and responsibilities at that particular PGY level. All PGY levels and
rotating medical students will receive quarterly sessions during weekly didactic
conference. Topics include roles and responsibilities, communication, ethnic and
cultural sensitivity, mutual respect for all team members, social media, leading by
example, teaching tools and techniques, patient satisfaction, competent consultations,
delivering difficult news, challenging patients, and dealing with difficult people.
Learners will receive 360-degree evaluations during their ED rotations from
patients, peers, nurses, students, and ancillary staff.
Conclusion: PP is a structured curriculum filling the void in education of PICS.
Considerable resident involvement makes this curriculum palatable and successful.
This curriculum is highly transferrable, and deserves a place in the every emergency
medicine educator’s toolbox.
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