Diane L. Gorgas

The Use of Reflection in Emergency Medicine Education

Reflection is a cognitive process in which new information and experiences are integrated into existing knowledge structures and mental models, resulting in meaningful learning. Reflection often occurs after an experience is over, promoting professional development and lifelong learning. However, a reflective emergency physician (EP) is also able to apply reflection in real time: self-monitoring, coping with the unexpected, and quickly thinking on his or her feet to solve complicated, unique, and challenging clinical problems. Reflection is a skill that can be taught and developed in medical education. Evidence demonstrating the value of teaching reflection is emerging that substantiates longstanding educational theories. While a few educators have started to explore the use of reflection for emergency medicine (EM) learners, the potential for broader application exists. This review summarizes the literature regarding reflection in medical education and provides a basic primer for teaching reflection.

Infections Related to Pregnancy

Infections in pregnancy and in the postpartum period represent an important knowledge base that emergency physicians should have. Being able to understand the risk that pregnancy-related infections have on maternal and fetal health in addition to the initiation of appropriate treatment for these infections is crucial. In the postpartum period, most infections (94%) are likely to manifest after hospital discharge; therefore, patients frequently present to the emergency department.

Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents

Introduction Emotional Intelligence (EI) is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents. Methods This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p≤0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training. Conclusion Our brief EI training showed a delayed but statistically significant positive impact on EM residents six months after the intervention involving SPT. One possible explanation for this finding is that residents required time to process and apply the EI skills training in order for us to detect measurable change. More rigorous measurement will be needed in future studies to aid in the interpretation of our findings.

Advanced topics in emergency medicine: curriculum development and initial evaluation.

Background Emergency medicine (EM) is a young specialty and only recently has a recommended medical student curriculum been developed. Currently, many schools do not require students to complete a mandatory clerkship in EM, and if one is required, it is typically an overview of the specialty. Objectives We developed a 10-month longitudinal elective to teach subject matter and skills in EM to fourth-year medical students interested in the specialty. Our goal was producing EM residents with the knowledge and skills to excel at the onset of their residency. We hoped to prove that students participating in this rigorous 10-month longitudinal EM elective would feel well prepared for residency. Methods We studied the program with an end-of-the-year, Internet-based, comprehensive course evaluation completed by each participant of the first 2 years of the course. Graduates rated each of the course components by using a 5-point Likert format from “strongly disagree” to “strongly agree,” either in terms of whether the component was beneficial to them or whether the course expectations were appropriate, or their perceptions related to the course. Results Graduates of this elective have reported feeling well prepared to start residency. The resident-led teaching shifts, Advanced Pediatric Life Support certification, Grand Rounds presentations, Advanced Cardiovascular Life Support proficiency testing, and ultrasound component, were found to be beneficial by all students. Conclusions Our faculty believes that participating students will be better prepared for an EM residency than those students just completing a 1-month clerkship. Our data, although limited, lead us to believe that a longitudinal, immersion-type experience assists fourth-year medical students in preparation for residency.

Use of a secure social media platform to facilitate reflection in a residency program.

BACKGROUND Reflective writing is used to promote learning and professional growth in medical education. Sharing reflections with peers and supervisors facilitates feedback that enhances understanding. OBJECTIVE We explored the feasibility of using a secure social media platform to share reflections and promote reflective discussions in an emergency medicine residency program. METHODS This was a prospective pilot investigation evaluated with a poststudy opinion survey. Reflective discussions were also described using basic quantitative and qualitative methods. RESULTS The 2-month, voluntary, pilot study included 21 faculty and 36 residents. Faculty posted reflections and replies (n  =  146) more frequently than residents did (n  =  48). Survey data suggested both groups found the platform engaging and easy to use, valued the security of the platform, and felt the conversations were valuable to their professional development. CONCLUSIONS Secure social media offers a feasible option for sharing reflections and facilitating reflective discussions in medical education.

Novel Emergency Medicine Curriculum Utilizing Self- Directed Learning and the Flipped Classroom Method: Obstetric and Gynecologic Emergencies Small Group Module

Author(s): McGrath, Jillian; Mesiwala, Arwa; Barrie, Michael; Boulger, Creagh; Thompson, Laura; Mitzman, Jennifer; Gorgas, Diane; Emerson, Geremiha; Khandelwal, Sorabh; Tyransky, Alyssa; King, Andrew

‘Speed advising’ for medical students applying to residency programs: an efficient supplement to traditional advising

Background Over time, Residency Match dynamics fluctuate with some specialties experiencing increases in medical student popularity. Academic departments with limited resources must devise methods for coping with increased demand for their specialty. Students perceive traditional programs on Match mechanics as inadequate. Subsequently, faculty are confronted with demands for more personal attention from more students. Objectives We developed a strategy for providing specialty-specific residency match advising to large numbers of students. Methods The ‘speed-advising’ session (SAS) was developed to address the common questions and concerns that medical students pose during the Match process and to provide advisees with a breadth of faculty perspectives. Two SASs were offered over a 2-week period. After the sessions, students and faculty were surveyed regarding their experience. Results Twenty-six students pursued our specialty in the 2015 Match (26 of 234, 11.1%). Twenty-three (89%) participated in the SAS. Seventy-four percent of students (17 of 23) and all faculty completed the post-session survey. Students found the SAS to be informative, helpful and an efficient use of time. Common discussion topics included: career goals, to which programs and how many to apply, and how academic record impacts their likelihood of matching in our specialty. Students would have preferred more time with each faculty; however, most (77%) conceded that their questions were adequately answered. Faculty-favored speed advising over traditional advising (86%), primarily due to estimated time savings of 7.3 h per faculty member. Conclusions In preparing students for the Match, specialty-specific speed advising offers an efficient supplement to traditional advising.Background Over time, Residency Match dynamics fluctuate with some specialties experiencing increases in medical student popularity. Academic departments with limited resources must devise methods for coping with increased demand for their specialty. Students perceive traditional programs on Match mechanics as inadequate. Subsequently, faculty are confronted with demands for more personal attention from more students. Objectives We developed a strategy for providing specialty-specific residency match advising to large numbers of students. Methods The ‘speed-advising’ session (SAS) was developed to address the common questions and concerns that medical students pose during the Match process and to provide advisees with a breadth of faculty perspectives. Two SASs were offered over a 2-week period. After the sessions, students and faculty were surveyed regarding their experience. Results Twenty-six students pursued our specialty in the 2015 Match (26 of 234, 11.1%). Twenty-three (89%) participated in the SAS. Seventy-four percent of students (17 of 23) and all faculty completed the post-session survey. Students found the SAS to be informative, helpful and an efficient use of time. Common discussion topics included: career goals, to which programs and how many to apply, and how academic record impacts their likelihood of matching in our specialty. Students would have preferred more time with each faculty; however, most (77%) conceded that their questions were adequately answered. Faculty-favored speed advising over traditional advising (86%), primarily due to estimated time savings of 7.3 h per faculty member. Conclusions In preparing students for the Match, specialty-specific speed advising offers an efficient supplement to traditional advising.

High incidence of interpersonal violence in Northwest Ethiopia: A cross-sectional study

BACKGROUND Interpersonal violence has devastating consequences for the mental, physical and sexual health of the victim. It is a leading cause of injury in east Africa. Studies in Ethiopia report that the most common cause of injury was interpersonal conflict. Our objective was to study the incidence of interpersonal violence related injury and associated factors among patients visiting the emergency department of University of Gondar Hospital, Northwest Ethiopia. METHODS A cross-sectional institutional based study design was employed from November 2013-June 2014. The source population was a cohort sample of all patients presenting for treatment of a traumatic injury. Data were collected using injury surveillance guidelines developed by the World Health Organization. Bivariate and multivariate logistic regressions were performed to identify the presence and strength of association. Odds ratio with 95% confidence interval was computed to determine the level of significance. RESULTS The overall incidence of interpersonal violence related injury was 28.5% of all emergency department trauma patients. Multivariate logistic regression shows that conflict in the family prior to the event [AOR = 9.9 (95% CI: 4.433-9.536)], poor behavioral control [AOR = 2.5 (95% CI: 1.192-5.460)], alcohol use [AOR =  .406 (95% CI: 1.813-6.398)] and paternal education [AOR = 2.441(95% CI: 1.209-4.929)] were found to be independently associated with interpersonal violence related injury. CONCLUSION AND RECOMMENDATION The incidence of interpersonal violence related injury was high. Counseling and education on conflict resolution methods should be given for the community using mass media.

Tracheal diverticulum masquerading as pneumomediastinum in a trauma victim

BACKGROUND The differential diagnosis for a paratracheal air collection includes Zenker diverticulum, tracheal diverticulum, apical herniation of the lung, and pneumomediastinum. In the setting of trauma, pneumomediastinum is traditionally regarded as an alarm sign that warrants investigation for tracheal or esophageal rupture,both highly morbid conditions. CASE REPORT A patient presented to the emergency department with neck pain several hours after being involved in a low-speed,side-impact automobile collision. She was discharged with analgesics after cervical spine radiographs showed no fracture and physical examination found no neurological deficits. She returned 18 days later with retrosternal pain and worsening neck pain, and cervical computed tomographic scan demonstrated an abnormal paratracheal air collection. Follow-up chest computed tomographic scan identified a right-sided tracheal diverticulum without evidence of pneumomediastinum.