Free eBook Announcement: Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds)

emergency medicine resident simulation curriculum for pediatrics EM ReSCu Peds

 

The Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) is here! This free ebook contains 16 EM resident-tested, peer reviewed cases covering essential pediatric content identified through a robust modified Delphi process [1] with experts across the United States. Each chapter contains robust supporting materials to help educators prepare, execute, and debrief cases with residents at every level to help supplement the clinical experience.

Download the EM ReSCu Peds eBook

We request some basic demographic about you and how you plan to use the educational cases in the download form to provide us with necessary insights whether there is a need for such a resource.

A National Collaborative Effort

Cases were created and iteratively peer reviewed by members of 10 organizations represented in a national collaborative of EM, PEM, and simulation experts. Participating organizations included:

  • American Academy of Emergency Medicine
  • American Academy of Pediatrics
  • American College of Emergency Physicians
  • Council of Emergency Medicine Residency Directors
  • Emergency Medicine Residents’ Association
  • International Network for Simulation-based Pediatric Innovation, Research, & Education
  • International Pediatric Simulation Society
  • Pediatric Trauma Society
  • Society for Academic Emergency Medicine
  • Society for Simulation in Healthcare

In total, EM and PEM physicians from 44 institutions participated in the development process of this educational resource aimed at preparing EM residents to care for critically ill children.

 

Reference

  1. Mitzman J, Bank I, Burns RA, et al. A Modified Delphi Study to Prioritize Content for a Simulation-based Pediatric Curriculum for Emergency Medicine Residency Training Programs. AEM Educ Train. 2019;4(4):369-378. Published 2019 Dec 12. doi:10.1002/aet2.10412
By |2021-01-09T11:52:36-08:00Jan 12, 2021|Pediatrics, Simulation|

SAEM Clinical Image Series: What Lies Beneath?

abscess

A 35-year-old male with a history of diabetes and pericarditis, status post pericardiectomy 3 years ago, presented with a painful lesion on his anterior chest wall. One month prior, the patient reported a bump at his sternotomy scar base which extruded a piece of suture when squeezed and subsequently healed. Two days ago, the patient developed diffuse right-sided chest pain. During the past 24 hours, an enlarging, erythematous, painful, non-draining lesion developed at the base of his scar. He reports subjective fever. He denies shortness of breath, exertional chest pain, nausea, and vomiting.

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SAEM Clinical Image Series: Left Ear Mass

ear mass

A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “pimple” and has been increasing in size for the last 6 months. He has an associated headache, dizziness, and malaise. He denies fever, trauma, drainage, known insect bite, dysphagia, dyspnea, trismus, and hearing loss. He emigrated to the United States from Honduras 8 months ago. He was seen in the emergency department 4 months prior for a similar complaint, which was diagnosed as lymphadenopathy by point-of-care ultrasound.

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How I Work Smarter: Jaime Hope, MD

Jaime Hope

One word that best describes how you work?

Systematically

Current mobile device

iPhone 11

Computer

Dual-monitor PC

What is something you are working on now?

An educational product to help elderly adults discover their risk factors for falls and use prevention strategies for fall prevention.

How did you come up with this Idea/Project?

Falls are the main cause of morbidity and mortality in older adults, we see this daily on shifts. Helping them reduce trip hazards and improve balance, proprioception, and strength can make substantial reductions in falls.

What’s your office workspace setup like?

Dual monitors (lots of open tabs!!) with all of the supplies I need within reach. My walls have calendars and lists of upcoming events as well as inspiring quotes and pictures that make me smile.

Jaime Hope setup part 1

Jaime Hope setup part 2

 

What’s your best time-saving tip in the office or home?

Taking the time and effort up front to get organized and systematized up front will save you a lot of time down the road! I have baskets for upcoming stuff, to-do lists (prioritized in order) at hand, and I color code things for ease of use. I also have a sheet of paper with each project I am working on (heading at the top) and when an idea comes to me, I add it on the paper. When I am ready to tackle the project, I captured all of the ideas and I’m ready to roll!

What’s your best time-saving tip regarding email management?

I am not glued to my inbox. Answering every ding is a distraction and can pull me away from other high-yield activities and take time with task switching. Setting aside time in the morning and afternoon to check emails protects my other productivity time from being interrupted.

What apps do you use to keep yourself organized?

Reminders and Anylist are the 2 I use most frequently. I also use the Notes app a lot to capture ideas for articles, talks, projects that come up when I’m on the go

How do you stay up to date with resources?

‘Reading’ is an important part of my schedule – whether that is a physical journal, a podcast, an audiobook, or strategic social media postings. Having time scheduled for this on a regular basis makes a difference in staying current! Also, utilizing ‘mindless’ task time, such as laundry, cleaning, driving, etc for audio content has been very helpful in remaining up to date.

What’s your best time-saving tip in the ED?

Be present with your patients and listen actively. Stay curious and ask questions. It seems more time-consuming at the moment but will save you lots of time down the road in missed diagnoses, patient complaints, lawsuits, and bad outcomes. That extra time with patients, in the grand scheme, not only make you a better clinician, it saves you a lot of downstream stress.

ED charting: Macros or no macros?

Yes macros! BUT don’t ever pre-enter a macro or have it tick off stuff you didn’t ask or examine. It is a slippery slope, don’t set a toe on it! My EMR also allows time-saving dot phrases, which I utilize frequently and again follow the firm rule don’t chart it until it happened.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

Remove unnecessary stuff from your cognitive load so you can concentrate your mental energy on what is most important. I use a paper with patient stickers to keep track of who I’ve staffed. I use a 4-color pen to take notes as I ’round’ on my staffed patients so you don’t forget something when the next distraction arises. Memorize the important stuff for crashing patients and know what tools you can use to look up anything you need.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Self-care isn’t selfish!! Make sure you get nourishing food, energizing exercise, restorative sleep, stress release, and meaningful connection in your life. A healthier you makes a better (and more patient!) doctor!

  • Is there anything else you’d like to add that might be interesting to readers?

Concentrate on what is most important first, and that is patient care. The patient’s ‘wait’ clock starts when you leave the room. They are scared and unsure and waiting. Updating them makes a huge impact on their care and ensures you have all of the info you need for the best diagnostics and therapeutics. You should be going in the room multiple time, other than for the simplest cases.

Who would you love for us to track down to answer these same questions?

  • Dr. Ryan McKennon DO, JD @RyanMcKennon

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2021-01-06T09:42:28-08:00Jan 8, 2021|How I Work Smarter, Medical Education|

SAEM Clinical Image Series: Blisters, Bullae, and Badness

blisters bullae

A 3-year-old female with a history of epilepsy presents with a rash that began one day ago. The patient started becoming fussy four days ago, saying, “I don’t feel good,” and not wanting to play outside with her siblings or finish her meals. Family noticed the patient rubbing her eyes frequently and crying when she went to the bathroom. She felt warm so they gave her Tylenol and Motrin at home. Yesterday, they noticed a rash was starting to develop with itchy, painful red spots. This morning, the rash progressed to involve some blisters on the face, chest, and back.

Medications include Tylenol, Motrin, and lamotrigine, which was started by her neurologist three weeks ago. Family history is significant for epilepsy on the father’s side of the family.

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By |2021-01-05T13:23:34-08:00Jan 4, 2021|Academic, SAEM Clinical Images|

How I Work Smarter: Drew Kalnow, DO

Drew Kalnow image

One word that best describes how you work?

Conscientiousness

Current mobile device

iPhone X

Computer

MacBook Air

What is something you are working on now?

InSitu EM Simulation

How did you come up with this Idea/Project?

Identified the need to improve critical patient care in the ED. This project uses senior residents as resus leaders with the ED critical patient team in one of our ED resus bays. Through this, we improved team communication and understanding of work-flows while also identifying and addressing latent safety threats.

What’s your office workspace setup like?

Most of my work is done in my home “office” currently. I work in our 3rd-floor loft away from most of the other house distractions. There is good natural and artificial lighting, room to spread out and with my AirPods Pro headphones, I can get down to business. Also, have a microphone and sound barriers that can be easily set up when podcasting or giving virtual lectures. When I am at the hospital, I use a shared workspace with other faculty, mainly my laptop at a desk, only using the hospital computer system if needed since it is much less portable and has built-in firewalls.

 

What’s your best time-saving tip in the office or home?

Having a to-do list with some general time allotments is a must. Knowing what tasks need to be accomplished when I start my day and giving myself a time limit to try and complete the task is critical. Part of this is also being realistic and honest with myself about what I am going to work on and how much is going to get completed. I can’t just say “work on X manuscript” and hope to be productive, I am much more specific with my todo list, breaking things up into accomplishable sub-tasks. Nothing begets productivity more than feeling like you are being productive checking things off your list, some go so far as to include making your bed, just to be able to check something off at the start of the day. Oh, and a really good cup of coffee and music helps too (pre-COVID, the local coffee shop often served as my office space).

What’s your best time-saving tip regarding email management?

Don’t rely on email to be your task manager. Find a way to move to-do items into another format that actually works. There are lots of apps that do this, or it can be done manually using notes or a calendar. Part of this is also staying on top of emails, if not addressing the email right away, placing it (or the todo item) somewhere that it will actually get done. For example, when I got the email asking me to write this article, I sent it to Todoist and scheduled it for a day I knew I could get it done. This is especially important when working out of multiple emails (I have 3).

What apps do you use to keep yourself organized?

Todoist has become my main project manager. It’s an intuitive app that syncs well with the google platform so I can link google drive files to it and also have it link to my master calendar (I use Google for this). I still use the sticky note function on my computer so that my “big ticket” items stay in the front of my mind, even if there is not an immediate deadline. Finally, I use good old fashion 3×5 index cards to take notes about projects when I am at my home or office desk. If I need to make an electronic version to work off of, I will either in notes or google doc and link those into Todoist, but often they stay at my desk as a reminder of ideas or subtasks for the projects I am working on.

How do you stay up to date with resources?

Being an active consumer of social media keeps me up to date on what is going in EM and medicine in general. I am an avid podcast listener,, staying up to date on the hot topics but also reviewing core content and more of the social conversations ongoing in medicine. It also helps that I also produce content through the EM Over Easy Podcast and some other sources, kind of hard to be active in that realm without knowing what’s out there too.

What’s your best time-saving tip in the ED?

In Box Zero – totally stolen from the email management concept, but it is crucial to success in the ED. I complete my charts at the time of dispo, often the only time I chart. This minimizes times spent in the chart but also ensures that I am not occupying bandwidth for patients I am no longer actively caring for and can leave my shift essentially on time. I also make sure everything else in my EMR inbox is done before I leave my shift, sign APP attestation notes, verbal orders, etc. That way, I leave the hospital and start my next shift with an empty clinic to-do list.

ED charting: Macros or no macros?

Yes to physical exam macros and basic care charts but ABSOLUTELY NOT medical decision making. I firmly believe that MDM macros cloud the chart and make it harder for another provider to actually discern what is going on with the patient. I can’t tell you how many charts from other providers I have looked at, that I have no idea what they were thinking with patient care because the chart is all macros. That may work for billing and legal purposes, but ultimately, the chart needs to drive patient care forward and tell your story of how and why you cared for the patient.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

Balance – the person that introduced me to Todoist recommended that the first item needs to be about your personal/family life. This is so important to being productive and not burning out. Keep perspective on what is important, and that does not always need to be work.

It’s okay to say no – I am finally at a place professionally that I am beginning to say no to projects that I am not currently interested in or don’t have time for. It is such a hard thing to do, but it is crucial to maintaining balance and sanity. The key is to say no in a way that keeps doors open or even moves the project forward by referring it on to someone else.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Decide who you want to be in terms of your medical career. This might seem a bit strange at first, but I think it helps to provide focus and context as you are starting out. What are your interests that you will focus on and what type of career do you think you want? Part of the question is checking in on the person you are as a whole and making sure your medical persona and trajectory are true to you.

  • Is there anything else you’d like to add that might be interesting to readers?

Do the Next Right Thing – This is beyond cheesy but so true. If you can say to yourself, I am doing the next right thing for me, my family, my patients, my career, then you are doing really well. BTW, this is totally stolen from a song in Frozen 2, which I have watched countless times with my 3yo, “I’ve seen dark before, but not like this. This is cold, this is empty, this is numb…But you must go on and do the next right thing”.

Who would you love for us to track down to answer these same questions?

  • Tanner Gronowski, @MOX13
  • Rodney Fullmer, @Dr_Fullmer
  • Katie Fisher, @KatieFisherEM
  • Katie Holmes, @KatieHolmesEM

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2020-12-20T10:20:12-08:00Dec 30, 2020|How I Work Smarter, Medical Education|

Defying Forgettable Flatness: The Power of Moments | Summary of The Leader’s Library Discussion

The Power of Moment book for the Leader's Library

In September, ALiEM hosted its fourth iteration of The Leader’s Library, this time discussing The Power of Moments by Chip Heath and Dan Heath [Amazon link to book]. Driven by a purpose “to defy the forgettable flatness of everyday work and life by creating a few precious moments,” 30 participants and 6 facilitators embarked on a 3-day voyage through the book, exploring general themes of CREATE (how do we manipulate our surroundings to create powerful moments?), REFLECT (how have powerful moments influenced our personal and professional lives?), and CAPITALIZE (how can we utilize moments to effect change and progress?). The interprofessional group of participants hailed from 6 countries, representing all levels of training, with local, regional, state, national, and international leadership experience. Lots of lived moments to contemplate!

The authors explain that for a moment to jump out at us and really stick, influencing our outlook and changing our behavior (a “defining moment”), the moment must:

  • Elevate us: pull us up from the mundane into something special (ex. a colleague brings you a fancy latte on shift to celebrate your birthday), and/or
  • Deepen our insight: change our understanding of the world (ex. hearing a speaker who completely reframes the way we’d always viewed a topic), and/or
  • Instill pride: help us see ourselves and others at our best, and be proud of this (ex. public recognition at faculty meeting for a job well done), and/or
  • Create connection: link us with others (ex. current residents, faculty, and alumni celebrating together at residency graduation)

Once we understand these critical components of defining moments, we can then engineer our environments to create these moments intentionally. Whether a person is a community provider seeking to spice up their on-shift work, or a residency program director hunting for ways to boost morale in a tough year, or the director of a regional disaster response during a pandemic– all of us in emergency medicine could use some extra powerful moments in our lives.

Day 1: Create

The first day of The Leader’s Library started with participants describing particularly memorable moments in their lives. Inevitably, the conversation shifted to the concepts of time and timing, and a nuanced discussion ensued around our relationship with the two (how is a minute different from a moment?). In the Greek language there are two words for time: chronos and kairos. Most of our professional energy is spent focusing on time (chronos), while most meaningful moments are more significantly influenced by timing (kairos); participants discussed how we can shift our worlds more toward kairos to maximize great moments. (For example, selecting a kairos time to deliver important feedback might create a defining moment for the recipient, while a feedback session centered around chronos is just another meeting.) 

We then contemplated how mindset can affect moments, and whether people with a growth mindset inherently experience moments differently than ones with a fixed mindset (participants felt that they do– a growth mindset allows an individual to recognize a low point or “pit” as a valuable learning opportunity, a powerful moment, while a fixed mindset might only perceive an obstacle). 

We then discussed transition. Acknowledging that many memorable moments happen during times of transition (birthdays, graduations, weddings, funerals), how can we as leaders and educators choreograph inevitable transitions (such as the start of a new rotation, or the beginning of a new postgraduate year of training) to maximize and enhance the experience for our learners? Participants shared a wealth of great ideas, such as a resident receiving the “golden laryngoscope” trophy once they’ve signed off on intubations, bringing a cake to a trainee’s last shift of residency and sending a picture of them cutting it to their family, and welcoming a resident who’s been lost in off-service land with a cup of coffee and a granola bar on their first shift back in the ED. 

Lastly, we explored how we can maximize moments in non-transitions. The authors write that “breaking the script” can help elevate an everyday experience into a powerful moment, and ideas our readers had included holding small meetings outside, taking a walk with a mentee instead of sitting in an office, and giving kudos spontaneously when it’s earned, rather than storing it up for a semi-annual evaluation.

Day 2: Reflect

On day 2, we turned inward to reflect on defining moments, both positive and negative, that we’d experienced over the course of our lives and careers. One participant applied the chicken-egg paradox to moments, and wondered if moments are external stimuli that happen to us and shape the stories we tell ourselves to make sense of the universe around us, or if moments are only perceived and noticed after an internal reflection process– do moments shape our stories, or do our stories shape our moments? The consensus was a resounding YES (to both). 

We explored the authors’ proposed formula for leaders seeking to stretch their team members into growth– many participants work with learners of all stages, and easily applied these managerial concepts to medical education. The Heaths argue that (high standards + assurance) + (direction + support) = enhanced self insight, or personal growth. How might this look in medicine? A faculty member working on a manuscript with a trainee might say, “I wrote several revision suggestions. I expect high-quality writing out of you, and know you can achieve it. I pulled some examples of outstanding scientific writing for you. We’ll meet again next week, and I’m available by e-mail in the interim.” This sure has a different impact than simply sending the trainee a document full of markup and critiques! By applying this formula and thinking in moments, we shifted this encounter from discouraging to motivating, from banal to defining, all with an extra 1-2 minutes of effort.

Early career participants reflected that this might be easier in theory than in practice; one participant stated, “The knife’s edge balance of being shamed vs having high expectations placed on us, then living up to them, is crazy!” A mid-career participant sagely counseled, “As I’ve continued to have fascinating professional opportunities, I find that less surprises me and fewer things wound me. Cultivating equanimity… and caring about life, but with a certain indifference to the details, helps transform a wider array of experiences into growth opportunities rather than moments of hurt.” Yet again we returned to the premise of thinking in moments facilitating continual professional development and evolution.

We closed day two with a discussion of purpose vs passion. Although “passion” seems like an exotic way to fuel one’s career, the authors maintain that “purpose trumps passion:”

Passion is individualistic. It can energize us, but also isolate us, because my passion isn’t yours. By contrast, purpose is something people can share. It can knit groups together.

Successful leaders can cultivate a shared purpose in their organization, so everyone (passionately) fulfills their roles to the best of their ability toward this common purpose– from respiratory therapists to attending physicians to child life specialists, each team member is united in this purpose. And how do we unearth such purpose? By asking a series of “whys.” The authors use a great example from healthcare, querying a hospital custodian:

  • Why do you clean hospital rooms? “Because that’s what my boss tells me to do.”
  • Why? “Because it keeps the rooms from getting dirty.”
  • Why does that matter? “Because it makes the rooms more sanitary and more pleasant.”
  • Why does that matter? “Because it keeps the patients healthy and happy.”

Narrowing the scope from organizational to individual, one participant mused that this exercise could have incredible value as one contemplates one’s own career, or scaffolds a mentee as they generate a 5 year plan, although “it almost seems invasive, like if I did it in a residency interview it would be too much… but not too much for me alone with a piece of paper, and maybe not too much for a conversation with a learner struggling to find their purpose, if it felt safe for them to look that deep.”

Day 3: Capitalize

Discussion on day 3 focused on actions we can take to make the most of the moments, both big and small, that we experience and create throughout our careers. We discussed several ways of highlighting little moments we experience every day. Some participants plan to ask themselves and their learners after a shift about what they learned and who they learned from to highlight and celebrate that learning and teaching, and to cultivate a gratitude practice. Monthly didactics can be reframed from a residency requirement to an opportunity to create positive moments for learners– a chance to celebrate milestones and forge connection. Participants reflected that sharing one’s own journey and personal defining moments can spark new powerful moments for others. One person shared a cool practice: “I am pretty old school and prefer to read paper books. I have a habit when I finish reading a book, I write my major learning points inside the cover, and then I think of someone to give the book to, or sometimes mail to. Eventually this process is repeated, and that inside cover is chock-full of amazing ways the book has inspired people.” Mind blown.

The Power of Moments: Take home quotes from our discussion

Several discussants plan to do something similar; we’ll close this post with some major messages they would write inside the cover of this book. Thanks to our outstanding facilitators, engaged participants, and you, the ALiEM community, for constantly pushing your leaders to grow. Hope to grow with you at The Leader’s Library, V5 in the spring!

“I’d write the table of contents… It really sums up so many of the key points of the book and in very few words.” – Table of contents: Defining Moments. Thinking in Moments. Build Peaks. Break the Script. Trip Over the Truth. Stretch for Insight. Recognize Others. Multiply Milestones. Practice Courage. Create Shared Meaning. Deepen Ties. Making Moments Matter.

“Small moments can have great impact as defining moments. Commemorate milestones, no matter how small.”

“We remember our lives as a series of moments, good or bad, large or small. While many moments happen organically, some can be created, engineered, or encouraged. Remember your moments and learn from them. Encourage positive moments for those around you.”

“Pause. Soak up the present. You could be missing out on a moment that could impact you or someone around you. Try to make it a better moment.”

And, a final quote from she who started it all, Dr. Michelle Lin: “Moments matter. Pass it on.”

By |2020-12-15T09:24:17-08:00Dec 23, 2020|Book Club, Leaders Library|
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