Tracy Sanson

EVALUATION OF ABDOMINAL PAIN IN THE ELDERLY

Evaluation of the older patient presents a unique challenge to the emergency physician. The increased age of the population, a high incidence of comorbidity, general poverty of history and clinical signs in acute abdominal conditions, poor reliability of diagnostic procedures, and the variable presentations of diseases with significant morbidity and mortality summarize the problems to be encountered with the complaint of abdominal pain in the elderly. The correct diagnosis is often difficult to establish and coexisting complicating diseases influence the patients condition and the ED management. The emergency physician must maintain a wide differential and have a low threshold for admission and more extensive evaluation in this patient population.

Strategies for coping with stress in emergency medicine: Early education is vital

Introduction: Physician burnout has received considerable attention in the literature and impacts a large number of emergency medicine physicians, but there is no standardized curriculum for wellness in resident education. A culture change is needed to educate about wellness, adopt a preventative and proactive approach, and focus on resiliency. Discussion: We describe a novel approach to wellness education by focusing on resiliency rather than the unintended endpoint of physician burnout. One barrier to adoption of wellness education has been establishing legitimacy among emergency medicine (EM) residents and educators. We discuss a change in the language of wellness education and provide several specific topics to facilitate the incorporation of these topics in resident education. Conclusion: Wellness education and a culture of training that promotes well-being will benefit EM residents. Demonstrating the impact of several factors that positively affect emergency physicians may help to facilitate alert residents to the importance of practicing activities that will result in wellness. A change in culture and focus on resiliency is needed to adequately address and optimize physician self-care.

ELDERLY PATIENTS WITH ALTERED MENTAL STATUS

Mental status changes in the elderly are a source of concern and a challenge for the emergency physician. A variety of medical conditions and psychiatric disturbances are potential causes of those symptoms. Acute changes must be differentiated from mental status alterations occurring as a result of chronic conditions. This article focuses on the emergency evaluation, treatment, and differential diagnosis of this symptom complex.

Guidelines for Safety of Trainees Rotating Abroad: Consensus Recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association

The goal of a global health elective is for residents and medical students to have safe, structured, and highly educational experiences. In this article, the authors have laid out considerations for establishing a safe clinical site; ensuring a travelers personal safety, health, and wellness; and mitigating risk during a global health rotation. Adequate oversight, appropriate mentorship, and a well-defined safety and security plan are all critical elements to a successful and safe experience.

Academic affairs and global health: how global health electives can accelerate progress towards ACGME milestones

Global health electives (GHEs) have become a standard offering in many residency programs. Residency electives should aid residents in achieving outcomes in the Accreditation Council for Graduate Medical Education (ACGME) competency domains. In this paper, the authors review existing literature and provide expert opinion to highlight how global health electives can complement traditional training programs to assist residents in achieving ACGME milestones, using emergency medicine residency as an example. Recommendations are provided for identifying exemplary global health electives and for the development of institutional global health elective curricula in order to facilitate milestone achievement. Global health electives can advance progress towards ACGME milestones; however, they may vary greatly in terms of potential for learner advancement. Electives should thus be rigorously vetted to ensure they meet standards that will facilitate this process. Given that milestones are a newly introduced tool for assessing resident educational achievement, very little research is available currently to directly determine impacts, and further study will be needed.

Preparing Emergency Physicians for Malpractice Litigation: A Joint Emergency Medicine Residency-law School Mock Trial Competition

BACKGROUND Fear of malpractice affects the daily life of many emergency physicians. Educational programs to prepare for litigation are lacking. OBJECTIVES An educational collaboration between an emergency medicine residency and a law school, whereby a medical malpractice mock trial competition is used to teach residents basic skills for testifying in legal proceedings. METHODS Ten residents in an academic emergency medicine program volunteered as witnesses in a malpractice mock trial competition at a law school. Residents testified two or three times and, after each appearance, were provided feedback to prepare them for subsequent rounds of testimony. They were also given access to videotaped testimony. Judges rated each resident using a nine-question survey scored on a 10-point Likert scale. Scores were compared as a group between rounds of testimony. RESULTS Participants demonstrated significant improvement in seven of nine measured categories. p-Values reached significance in: Worked Well on Direct Examination (p < 0.001), Demeanor/Body Language (p < 0.001), Was Not Arrogant/Did Not Lose Poise on Cross-Examination (p = 0.001), Convincing Witness (p = 0.001), Appeared Knowledgeable (p = 0.012), Courtroom Attire (p = 0.012), and Expressed Themselves Clearly (p = 0.017). In addition, residents anonymously reported broad educational benefit. CONCLUSION This novel educational collaboration taught residents about the process of litigation. It improved their communication skills and expanded their knowledge of documentation pitfalls, problems with staff interaction, and consequences of medical errors. This mutually beneficial partnership between a medical residency and a law school solidified it as a permanent feature of the residency program.

What's new in emergencies, trauma, and shock? JETS policy for publishing animal studies

Galen, an ancient Roman physician and philosopher, dissected pigs, apes, and other animals to further his understanding of human anatomy and physiology as the dissection of human corpses was against Roman law. More recent examples of physicians using animals to understand the workings of the human body include Drs. Frederick Banting and John Macleod who used dogs and later pigs to chemically isolate insulin for the treatment of diabetes in the 1920s. In the 1940s and 1950s, Drs. Jonas Salk and Albert Sabin used nonhuman primates to develop vaccines against the polio virus. Although an estimated 100,000 Rhesus monkeys were killed during the creation of the vaccines, they virtually eradicated polio in the United States and in other developed nations. Additionally, animal studies have enabled physicians to safeguard the population with vaccines against rabies, pertussis, and anthrax. Numerous medications including lithium and penicillin have also been derived from animal studies. Dr. Alfred Blalock used dogs to model physiological shock and developed protocols for cardiovascular resuscitation. These protocols were applied during World War II, saving countless lives. Dr. Blalock would build upon his work and ultimately, perform the first cardiac surgery. In the 1960s, Drs. Albert Starr and Alain Carpenter experimented on dog and pig models to pioneer the field of heart valve replacement and valve prosthetics.