Resident-As-Teacher: A Suggested Curriculum for Emergency Medicine

Resident teaching is a competency that must be recognized, developed, and assessed. The ACGME core competencies include the role of physician as educator to “educate patients and families” and to “facilitate the learning of students and other health care professionals.” Residents spend a significant proportion of their time in teaching activities, and students report achieving much of their clinical learning from their interactions with residents. Although many residents enjoy their critical role as teacher, many do not feel well prepared to teach. This article summarizes a preliminary curriculum of modules for a resident teacher‐training program for emergency medicine residents. The goal of these modules is to provide learning objectives and an initial structure through which residents could improve basic teaching skills. Many of these skills are adaptable to residents' interactions with each other and with students, other healthcare professionals, and patients. Each module and corresponding teaching exercises can be found at http:www.saem.org     

Does Simulator Training for Medical Students Change Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department?

Objectives: To determine how simulator training impacts patients' preferences about medical student procedures in the emergency department. Methods: A questionnaire was administered to a convenience sample of 151 of 185 patients approached (82% participation) seen in the emergency department of a midwestern teaching hospital. The questionnaire asked how many procedures they would prefer a medical student have performed after mastering the procedure on a simulator before allowing the medical student to perform this procedure on them. The procedures included venipuncture, placement of an intravenous line, suturing the face or arm, performing a lumbar puncture, placement of a central line, placement of a nasogastric tube, intubation, and cardioversion. These results were compared with those of a similar study asking about the same procedures without the stipulation that the skill had been mastered on a simulator. Results: A high of 57% (venipuncture) and a low of 11% (placement of a central line) would agree to be a student's first procedure after simulator training. Except for intubating and suturing, participants were more likely (p < 0.05) to allow a medical student to perform a procedure on them after simulator training than without simulator training. Many patients prefer not to have a medical student perform a procedure no matter how many procedures the student has done (low of 21% for venipuncture, high of 55% for placement of a central line). Conclusions: Patients are more accepting of medical students performing procedures if the skill has been mastered on a simulator. However, many patients do not want a medical student to perform a procedure on them regardless of the student's level of training.     

Highlights in Emergency Medicine Medical Education Research: 2008

Objectives: The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine. Methods: Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis‐testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review. Results: Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi‐experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies. Conclusions: This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.     

Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department

OBJECTIVES: To determine emergency department (ED) patients' preferences about having medical students perform procedures as part of medical student clinical training. METHODS: A questionnaire was administered to a sequential sample of 150 patients of 196 approached (76.5% participation rate) in a teaching hospital ED. Patients were asked how many procedures a medical student should have performed on other patients before the participant would allow the student to perform the procedure on them. The procedures included venipuncture, starting an IV, suturing the face, suturing the arm, performing a lumbar puncture, starting a central line, inserting a nasogastric tube, intubation, and cardioversion. RESULTS: If they had their preference, only a minority of patients would allow medical students to perform their first procedure on them for any of the procedures (a high of 42% for venipuncture, with a low of 7% for a lumbar puncture). Many patients prefer that medical students never perform a procedure on them (a high of 56% for a central line and a low of 21% for venipuncture). Patient beliefs were independent of age, gender, or insurance status. CONCLUSIONS: Patients are reluctant to be a medical student's first patient when it comes to procedures in the ED. This has implications for medical training and informed consent.     

Adapting Maslow's Hierarchy of Needs as a Framework for Resident Wellness

Issue: Burnout in graduate medical education is pervasive and has a deleterious impact on career satisfaction, personal well-being, and patient outcomes. Interventions in residency programs have often addressed isolated contributors to burnout; however, a more comprehensive framework for conceptualizing wellness is needed. Evidence: In this article the authors propose Maslow's hierarchy of human needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a potential framework for addressing wellness initiatives. There are numerous contributors to burnout among physician-trainees, and programs to combat burnout must be equally multifaceted. A holistic approach, considering both the trainees personal and professional needs, is recommended. Maslow's Needs can be adapted to create such a framework in graduate medical education. The authors review current evidence to support this model. Implications: This work surveys current interventions to mitigate burnout and organizes them into a scaffold that can be used by residency programs interested in a complete framework to supporting wellness.     

Integration of a Low‐Cost Introductory Ultrasound Curriculum Into Existing Procedural Skills Education for Preclinical Medical Students

We evaluated integration of an introductory ultrasound curriculum into our existing mandatory procedural skills program for preclinical medical students. Phantoms consisting of olives, pimento olives, and grapes embedded in opaque gelatin were developed. Four classes encouraged progressive refinement of phantom‐scanning and object identification skills. Students improved their ability to identify hidden objects, although each object type achieved a statistically significant improvement in correct identification at different time points. The total phantom cost per student was $0.76. Our results suggest that short repeated experiences scanning simple, low‐cost ultrasound phantoms confer basic ultrasound skills.