Michael C. Bond

Elder Abuse and Neglect Definitions, Epidemiology, and Approaches to Emergency Department Screening

Elder abuse and neglect is estimated to affect approximately 700,000 to 1.2 million elderly people a year with an estimated annual cost of tens of billions of dollars. Despite the large population at risk, its significant morbidity and mortality, and substantial cost to society, elder abuse continues to be underrecognized and underreported. This article aims to increase the awareness of elder abuse by reviewing the demographics, epidemiology, and risk factors of elder abuse, followed by a discussion of screening tools and ways to increase awareness and reporting.

Social Media Guidelines and Best Practices: Recommendations from the Council of Residency Directors Social Media Task Force

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand” the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence.

Evaluation of social media use by emergency medicine residents and faculty

Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p=0.0007]). Conclusion EM residents and faculty have different patterns and interests in the personal and professional uses of social media. Awareness of these utilization patterns could benefit future educational endeavors.

Molar Pregnancy-Induced Thyroid Storm

BACKGROUND Molar pregnancy is a rare form of pregnancy, affecting approximately 1 in 1000 pregnancies in the United States. Hyperthyroidism is a rare complication of molar pregnancy; thyroid storm occurs even less frequently. OBJECTIVES To discuss a rare cause of thyroid storm in a woman of reproductive age. CASE REPORT A 17-year-old girl presented to a community hospitals Emergency Department (ED) after experiencing 1 week of palpitations and tachycardia. The tachycardia partially responded to administration of calcium channel blockers and beta-blockers. The patient was transferred to a tertiary care center for further evaluation. At the tertiary center, pregnancy was confirmed, thyroid storm was diagnosed, and ultrasound examination yielded a snowstorm image, indicating a molar pregnancy. The patient was admitted to the intensive care unit for management. Dilatation and curettage resolved her symptoms, and after a 9-day hospital stay, she was discharged home on atenolol therapy. CONCLUSIONS Thyroid storm induced by gestational trophoblastic disease should be considered in any woman of childbearing age who presents with symptoms suggestive of hyperthyroidism.

Recommendations from the Council of Residency Directors (CORD) Social Media Committee on the Role of Social Media in Residency Education and Strategies on Implementation

Social media (SM) is a form of electronic communication through which users create online communities and interactive platforms to exchange information, ideas, messages, podcasts, videos, and other user-generated content. Emergency medicine (EM) has embraced the healthcare applications of SM at a rapid pace and continues to explore the potential benefit for education. Free Open Access Meducation has emerged from the ever-expanding collection of SM interactions and now represents a virtual platform for sharing educational media. This guidance document constitutes an expert consensus opinion for best practices in the use of SM in EM residency education. The goals are the following: 1) Recommend adoption of SM as a valuable graduate medical education (GME) tool, 2) Provide advocacy and support for SM as a GME tool, and 3) Recommend best practices of educational deliverables using SM. These guidelines are intended for EM educators and residency programs for the development and use of a program-specific SM presence for residency education, taking into account appropriate SM stewardship that adheres to institution-specific guidelines, content management, Accreditation Council for GME milestone requirements, and integration of SM in EM residency curriculum to enhance the learner’s experience. Additionally, potential obstacles to the uptake of SM as an educational modality are discussed with proposed solutions.

Computer Access and Internet Use by Urban and Suburban Emergency Department Customers

BACKGROUND Patients are increasingly using the Internet (43% in 2000 vs. 70% in 2006) to obtain health information, but is there a difference in the ability of urban and suburban emergency department (ED) customers to access the Internet? STUDY OBJECTIVE To assess computer and Internet resources available to and used by people waiting to be seen in an urban ED and a suburban ED. METHODS Individuals waiting in the ED were asked survey questions covering demographics, type of insurance, access to a primary care provider, reason for their ED visit, computer access, and ability to access the Internet for health-related matters. RESULTS There were 304 individuals who participated, 185 in the urban ED and 119 in the suburban ED. Urban subjects were more likely than suburban to be women, black, have low household income, and were less likely to have insurance. The groups were similar in regard to average age, education, and having a primary care physician. Suburban respondents were more likely to own a computer, but the majority in both groups had access to computers and the Internet. Their frequency of accessing the Internet was similar, as were their reasons for using it. Individuals from the urban ED were less willing to schedule appointments via the Internet but more willing to contact their health care provider via e-mail. The groups were equally willing to use the Internet to fill prescriptions and view laboratory results. CONCLUSION Urban and suburban ED customers had similar access to the Internet. Both groups were willing to use the Internet to access personal health information.

Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

BACKGROUND Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed. OBJECTIVES Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care-based milestones (PC 1-8), as assessed by faculty. Secondary objectives involved assessing what percentage of residents had achieved Level 1 as assessed by themselves, and finally, we calculated the absolute differences between self- and faculty assessments. METHODS Incoming PGY-1 residents at 4 EM residencies were assessed by faculty and themselves during their first month of residency. Performance anchors were adapted from ACGME milestones. RESULTS Forty-one residents from 4 programs were included. The percentage of residents who achieved Level 1 for each subcompetency on faculty assessment ranged from 20% to 73%, and on self-assessment from 34% to 92%. The majority did not achieve Level 1 on faculty assessment of milestones PC-2, PC-3, PC-5a, and PC-6, and on self-assessment of PC-3 and PC-5a. Self-assessment was higher than faculty assessment for PC-2, PC-5b, and PC-6. CONCLUSIONS Less than 75% of PGY-1 residents achieved Level 1 for ED care-based milestones. The majority did not achieve Level 1 on 4 milestones. Self-assessments were higher than faculty assessments for several milestones.

Cardiopulmonary resuscitation update.

Cardiopulmonary resuscitation (CPR) is vital therapy in cardiac arrest care by lay and trained rescuers. Chest compressions are the key component of CPR. Ventilation and airway management should be secondary to high-quality and continuous chest compressions in patients receiving CPR. Only after the patient has had return of spontaneous circulation or completed a cycle of CPR with defibrillation (if appropriate) should attempts at securing an advanced airway be made. Even then, interruptions of chest compressions should be minimized to maintain cardiocerebral perfusion and increase survival. Finally, the ventilation rate should be no more than 8 to 10 breaths per minute.

Podcasts: Accessing, Choosing, Creating, and Disseminating Content

Podcasts are audio files distributed via the Internet to share information asynchronously. Users can subscribe to podcasts (for automatic download), which offer highly customizable learning materials ideal for graduate medical education (GME). Users can now dictate the ‘‘who,’’ ‘‘what,’’ and ‘‘when’’ of their learning experience. Podcasts can vary in length and their episodic release can occur daily to monthly. Podcast use has grown exponentially relative to other asynchronous resources, with learners devoting the most time to podcasts and perceiving podcasts to be a more beneficial resource over traditional books and journals. Whether assigned by a faculty member or selected by a resident, podcasts enable trainees to acquire information at their own pace, are usually free of charge, and afford users immediate access to expert educators. For instructors, podcasts can deliver content to learners in advance of scheduled curriculum sessions to support application of knowledge through interactive learning activities. By recording key topics as downloadable content, educators can create podcasts that reach learners on the local, national, or international level. High-quality podcasts can also advance faculty careers and promote one’s program beyond its home institution.

Survey of Individual and Institutional Risk Associated with the Use of Social Media

Introduction Residents and faculty in emergency medicine (EM) residency programs might be unaware of the professional and legal risks associated with the use of social media (SM). The objective of this study was to identify and characterize the types and reported incidence of unprofessional SM behavior by EM residents, faculty, and nurses and the concomitant personal and institutional risks. Methods This multi-site study used an 18-question survey tool that was distributed electronically to the leaders of multiple EM residency programs, members of the Council of Emergency Medicine Residency Directors (CORD), and the residents of 14 EM programs during the study period May to June 2013. Results We received 1,314 responses: 772 from residents and 542 from faculty. Both groups reported encountering high-risk-to-professionalism events (HRTPE) related to SM use by residents and non-resident providers (NRPs), i.e., faculty members and nurses. Residents reported posting of one of the following by a resident peer or nursing colleague: identifiable patient information (26%); or a radiograph, clinical picture or other image (52%). Residents reported posting of images of intoxicated colleagues (84%), inappropriate photographs (66%), and inappropriate posts (73%). Program directors (PDs) reported posting one of the following by NRPs and residents respectively: identifiable patient information (46% and 45%); a radiograph, clinical picture or other image (63% and 58%). PDs reported that NRPs and residents posted images of intoxicated colleagues (64% and 57%), inappropriate photographs (63% and 57%), or inappropriate posts (76% and 67%). The directors also reported that they were aware of or issued reprimands or terminations at least once a year (30% NRPs and 22% residents). Residents were more likely to post photos of their resident peers or nursing colleagues in an intoxicated state than were NRPs (p=0.0004). NRPs were more likely to post inappropriate content (p=0.04) and identifiable patient information (p=0.0004) than were residents. Conclusion EM residents and faculty members cause and encounter HRTPE frequently while using SM; these events present significant risks to the individuals responsible and their associated institution. Awareness of these risks should prompt responsible SM use and consideration of CORD’s Social Media Task Force recommendations.