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Dear emergency physicians: We see you

The COVID-19 pandemic has placed incredible stress and strain on the personal work lives of emergency physicians. We have endured these almost 2 years of misinformation, PPE shortages, fear, frustration, grief, and death. So much going on in the world politically and socioeconomically, we at ALiEM wanted to share a message that WE SEE YOU. We’re with you, and we’re in this together.

Credits

Thank you for the tireless work on this video by animator Spencer Evans, who is a soon-to-be-emergency physician attending medical school currently at the University of Colorado. Also thanks to the entire ALiEM team for contributing to the message and storyboard, especially Drs. Al’ai Alvarez, Andy Little, Carl Preiksaitis, Chris Belcher, Christian Rose, Felix Ankel, Jason Woods, and Teresa Chan.

By |2022-03-09T11:05:28-08:00Mar 10, 2022|Academic, Emergency Medicine, Life, Medical Education|
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Education Theory Made Practical (Volumes 4 & 5): An ALiEM Faculty Incubator eBook Series

education theory made practical, volumes 4 and 5 cover book

Back by popular demand and thanks to a generous grant from the Government of Ontario’s eCampus initiative, the ALiEM team is delighted to announce the publication of 2 new eBook publications: Volumes 4 and 5 of the Education Theory Made Practical eBook series [ALiEM Library]. Like all of the others that have come before, these books were a labor of love brought to you by the dedicated Faculty Incubator alumni. On behalf of all the editors of both editions, we are very proud of all our Faculty Incubator alumni who made this happen. 

Their amazing contributions have been compiled in these FREE, peer-reviewed eBooks. We sincerely feel that these will be a useful resource for all the educators out there, wrestling with the issue of integrating theory into practice. Special shout-out to the incredible Dr. Jonathan Sherbino (Volume 4) and Dr. William Bynum (Volume 5) who authored the forewords and provided us with their thoughtful insights on how theory can relate to a clinician educator’s practice.  

Education Theory Made Practical volume 4 ETMP

Brought to you by the ALiEM Faculty Incubator Class of 2019-20

How to Cite This Book
Krzyzaniak, Messman, Robinson, Schnapp, Li-Sauerwine, Gottlieb, Chan (Eds). Education Theory Made Practical, Volume 4. McMaster Office of Continuing Professional Development, Hamilton, ON, Canada. ISBN: 978-1-927565-46-9 Available at: https://books.macpfd.ca/etmp-vol4/

Brought to you by the ALiEM Faculty Incubator Class of 2020-21

How to Cite This Book
Fant, Gottlieb, Li-Sauerwine, Krzyzaniak, Natesan, Schnapp, Chan (Eds). Education Theory Made Practical, Volume 5. McMaster Office of Continuing Professional Development, Hamilton, ON, Canada. ISBN: 978-1-927565-47-6Available at: https://books.macpfd.ca/etmp-vol5/

About the Books

The Education Theory Made Practical series aims to make the theoretical underpinnings of education psychology come alive for health professions teachers who are seeking to use theory to inform their clinical and classroom teaching.

Notes from Dr. Sara Krzyzaniak, the lead editor of Volume 4: I am proud of the authors’ work in writing primers on some of the core theories in medical education. The theories covered in this volume will help educators design (Cognitive Load Theory) and evaluate (Miller’s Pyramid) their curriculum. It will help us understand why our learners behave in a certain way (Maslow’s Hierarchy of Needs) and how we approach and organize abstract concepts in education (Prototype Theory). Check out the 10 chapters in Volume 4 to help you understand how we can use education theory to be more successful educators, learners, and scholars. 

Notes from Dr. Abra Fant, the lead editor of Volume 5: This volume explores 10 new theories which again cover the educational design process from start to finish. The IDEO Design Theory helps educators disrupt while designing, R2C2 provides an exceptional model for delivering feedback and the Logic Model is a wonderful resource for evaluating curricula. We invite you to explore these and other chapters to help provide background and context as you design, enact and evaluate your educational interventions. 

Our Process

As part of the Faculty Incubator program, a 2 -3 person team authored a primer on a key education theory on the International Clinician Educator (ICE) blog. These posts were published serially over a 10-week period. Each post featured a key educationally-relevant theory by starting with a vignette that situated the theory. Following this vignette, there was an explanation and short history of the theory followed by an annotated bibliography for further reading. To ensure high quality, we then asked the #MedEd and #FOAMed online communities to join us in peer-reviewing these posts. After incorporating many of the peer review comments, each blog post was converted into a book chapter within this volume of a series of books for budding clinician-educators – the Education Theory Made Practical series. We believe this will serve as a valuable tool on how to incorporate educational theory into the clinical realm in a practical way.

By |2022-02-24T19:22:33-08:00Mar 2, 2022|Academic, Faculty Incubator, Medical Education|
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How I Work Smarter: Simiao Li-Sauerwine, MD

One word that best describes how you work?

Efficiently!

Current mobile device

iPhone 12

Computer

MacBook Air

What is something you are working on now?

I’m working on a research study examining the impact of EM faculty demographics on learner evaluations.

How did you come up with this Idea/Project?

I’ve always been interested in the impact of implicit bias on physician professional development and advancement. We use learner evaluations of attendings for promotion, for compensation, for recognition with departmental awards. So, I was interested to know how the demographics of a faculty member might impact a resident’s expectations of how they teach at the bedside and on shift. Do they impact those metrics that affect advancement?

What’s your office workspace setup like?

My office in the Department of EM at OSU is right across from our Program Managers – very convenient for quick questions and discussions! I have a PC but often also bring my laptop for a centralized work machine. I have a French press with coffee and tea and mugs so that folks can get a caffeine fix when they stop by. I also make sure to have snacks available for quick nutrition between meetings.

My home setup is my MacBook Air on a laptop stand. About a year into the pandemic as I was continuing to work from home, I purchased the stand and it’s been a game-changer! Less neck strain and better angles for Zoom :). I usually work on the couch in our home office or wherever I can find a quiet space for deep work.

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

I have no magical time-saving tips but I keep an aggressively up-to-date to-do list which I re-prioritize every day. If it’s not on paper (or on my Notes app), it tends to fall off my radar. So everything gets written down.

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

Triage your email. I either glance at it, respond if necessary, and move on, or flag the email if it requires more thought or an in-depth response. Then, when I have blocks of time to sit down, the flagged emails become their own TO DO list. I try to keep this down to less than one page.

What apps do you use to keep yourself organized?

The Reminders app is nice because I can sync it across all my Apple devices. I use this primarily for groceries and personal TO-DOs. I use Notes for work-related tasks; each line is a deadline for a task (either real or self-imposed) with a title and descriptor.

How do you stay up to date with resources?

I go to our resident conference every single week – it’s a privilege to continue to learn. Free knowledge! Who doesn’t love that?

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

Save your teaching until after you’ve seen a patient, so you can focus on discussing the most relevant and high yield educational pearls.

ED charting: Macros or no macros?

No macros! It takes time to click through. I use dot phrases and change the text – it goes much quicker.

Advice

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

    Choose your projects based on 1. Are you passionate about the topic? 2. Are you really excited to work with the people involved? and 3. Will it build your dossier for promotion? Hitting one is great, two is better, and ideally all three! Wise words from Jorge Fernandez that have guided my junior faculty years.

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

    • Find your passion, and academic products will follow.
    • You are entitled to mentorship from anyone and everyone – don’t be afraid to ask for it.
    • Your personal brand is important – are you solutions-oriented, do you get things done, are you timely.
    • Work time is work time, and make it count – but protect your non-shift weekends and evenings for family and the stuff that matters.

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

    I am an avid foodie who loves to read up on local and regional specialties – so if you find me at a conference, ask me where to eat!

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

By |2022-02-21T07:41:22-08:00Feb 11, 2022|How I Work Smarter, Medical Education|
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EM Match Advice 36: It’s Time to Make Your Rank List

Now that interview season for residency match has concluded, our residency director panel tackles the hot topic of making your rank list, which includes “love letters” to programs and second look visits. In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host an esteemed panel of 3 program directors, Dr. Emily Fisher (University of Oklahoma), Dr. William Paolo (SUNY Upstate), and Dr. Michael Van Meter (University of Texas Health Science Center at Houston) to discuss these issues. Good luck to everyone in the match this year!

EM Match Advice Podcast

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/

By |2022-04-26T16:24:10-07:00Feb 9, 2022|EM Match Advice, Podcasts|
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Human Trafficking in the ED – What you need to know

Human trafficking is a devastating crime, where a human being’s labor is exploited through force, fraud, or coercion, for someone else’s profit (1). For survivors, connecting to support in the community can be incredibly difficult, and may come at the expense of their personal safety (1, 2).

The emergency department (ED) is a rare exception, with some studies estimating that over 60% of trafficked persons will present at some point during their exploitation to the ED (3). Unfortunately, less than 5% of emergency physicians report feeling confident in their ability to identify a trafficked person, citing confusion around patient characteristics and their role as a provider (4).

By learning more about human trafficking, ED providers can better prepare themselves to identify and provide appropriate support to those who experience human trafficking.

What can I do to be ready in the ED?

  • Understand what human trafficking is and its consequences
  • Recognize personal bias
  • Become familiar with how to identify, assess, document, and refer cases of human trafficking
  • Know your options for survivor advocacy

Click to view full-size image.

human trafficking overview infographic

Just the Facts – Human Trafficking

What is Human Trafficking?

Human trafficking always involves 3 components –an act, a means, and a purpose.

  • The “act” refers to the role a trafficker is playing in exploiting the person
  • The “means” refers to the use of force, fraud, or coercion to exploit a person
  • The “purpose” is what type of labor they are exploited for (1)

Often human trafficking will overlap with other crimes such as assault, domestic violence, rape, and child abuse (5). Of note, anyone under the age of 18 engaged in commercial sex is considered to be sex trafficked regardless of whether a means is present, as they cannot provide consent.

How many people are affected?

Human trafficking is widespread, but is often undetected, making true estimates of size difficult.

For example, human trafficking prevalence estimates may fail to account for survivors who do not recognize they are being exploited or are afraid to disclose (6, 7).

Who is trafficked?

 While no identity is spared, there are certain populations that are at greater risk. These may include:

  • People of color
  • Children in welfare and juvenile justice systems
  • Runaway and homeless youth
  • Children working in agriculture
  • Indigenous patients
  • Migrant laborers
  • Foreign national domestic workers
  • Patients with limited English
  • Patients with disabilities
  • Members of the LGBTQ community
  • Patients with limited education
  • Patients who use substances (6,8)

Why are they targeted?

The only thing all trafficked persons have in common is their vulnerability (1). Trafficking determinants can be conceptualized as “push” and “pull” factors. Push factors lead people to away from their current situation to trafficking (e.g., abuse, poverty, family conflict). Pull factors, drive an individual to something new that increases the risk of trafficking (e.g., income, housing, access to substances) (9, 10).

Who are the traffickers?

In the same way that anyone can be trafficked, anyone can be a trafficker.

Traffickers may be well known in the community, recruiting victims from places of employment or education (1). They may be a family member. They may also lure at-risk individuals by acting as a romantic partner, or by providing emotional affirmation, financial assistance, and material goods (1).

How do traffickers coerce survivors?

A number of tactics can be employed by traffickers, each tailored to the individual survivor but can include any combination of the following (1).

  • Physical violence
  • Sexual violence
  • Emotional violence
  • Withholding basic needs (food, water, shelter)
  • Intimidation
  • Coercion and threats
  • Economic coercion
  • Social isolation 

Specific situations to be wary of:

  • Runaway or homeless youth – greater incidence of “survival sex,” where sexual acts are exchanged for basic necessities (1, 11)
  • Recent immigrants – withholding documentation/ fear of deportation are used as powerful coercion tactic (1, 5, 6)

What are some of the health consequences of Human Trafficking (6)?

  • Physical abuse (traumatic injury, chronic pain)
  • Sexual abuse (sexually transmitted infections, pregnancy)
  • Emotional abuse (post-traumatic stress disorder, suicide ideation)
  • Poor living conditions (malnutrition, dehydration, exposure injuries)
  • Substance use, overdose
  • Death

10 Common Misconceptions of Human Trafficking

    human trafficking misconceptions

Click to view full-size images

Guide for Emergency Department Providers

What are the primary goals of an ED visit with a potentially trafficked patient?

  1. Address the acute presenting illness or injury
  2. Establish the ED as a haven from trauma or exploitation
  3. Offer additional resources, if appropriate and available

The goal of the visit is NOT to elicit a disclosure.

Your role as a provider is not to investigate or confirm the presence of trafficking, but to respect the autonomy of the patient in front of you, meet their healthcare needs, and empower them to seek additional support on their terms.

What steps should I take during my encounter?

  1. Capitalize on the same “trauma-informed” principles used to care for survivors of intimate partner violence and child maltreatment.
  2. Encounter tips (1, 6, 12)
    • Separate the potential victim from accompanying persons
  3. If difficult, ask the patient to move to another room for an x-ray or routine test.
    • Use a trained interpreter when required
    • Foster trust and establish rapport
    • Use education about rights and resources as an empowerment tool (12)
  4. Providing nonjudgmental education around violence and safety can normalize the sharing of information and open discussion (12)
    • Be patient
    • Always get consent before proceeding with any next steps (physical exam, diagnostic tests, and involvement of other providers)

human trafficking providers guide part 1     

Click for full-size images

Red flags For Human Trafficking (1, 13)

Patient IndicatorsCompanion Indicators
Delayed presentationRefuses to leave
Discrepancy between history and clinical presentationInsists on translating or speaking for the patient
Scripted/memorized historyControlling, interrupting
Hypervigilance, fearfulHas patient’s documents in their possession
Cannot produce identificationEmployer demanding access to medical information
Work-related injury with unsafe conditions
Fearful attachment to a cell phone (often used for communication and tracking)

Red flags for pediatric patients (1, 14)

  • Accompanied by unrelated, non-guardian adults
  • Material possessions you reasonably doubt they would be able to afford
  • Truancy or running away
  • Multiple sexual “partners”

What are the next steps after my assessment?

Any next steps should always be determined by the patient

  • Consider offering admission if unsafe to discharge
  • Clear and accurate documentation (may be relevant to future legal proceedings)
  • Consider notifying security if appropriate (6)

Unless local criteria for mandatory reporting are met, Police should only be contacted at the explicit instruction of the patient  (6, 16).

Interested in advocacy?

Consider implementing an ED and institutional protocol for human trafficking. A complete protocol guide is available through HEAL Trafficking.

References

  1. Alpert EJ, Ahn R, Albright E  et al. Human Trafficking: Guidebook on Identification, Assessment, and Response in a Healthcare Setting. Boston, MA: MGH Human Trafficking Initiative, Division of Global Health and Human Rights, Department of Emergency Medicine.
  2. Human Trafficking. Public Safety Canada, Government of Canada. 2019.
  3. Lederer L, Wetzel C. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Ann Heal Law. 2013;23(1):61–91.
  4. Viergever RF, West H, Borland R, Zimmerman C. Health care providers and human trafficking: What do they know, what do they need to know? Findings from the Middle East, the Caribbean, and Central America. Front Public Heal. 2015;3:1–9. PMID: 25688343
  5. Canada’s Human Trafficking Laws. British Columbia Public Health Agency. 2014.
  6. Shandro J, Chisolm-Straker M, Duber HC, Findlay SL, Munoz J, Schmitz G, et al. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Ann Emerg Med. 2016;68(4):501-508.e1. PMID: 27130802
  7. Global Report on Trafficking in Persons [Internet]. New York; 2014. Available from: https://www.unodc.org/res/cld/bibliography/global-report-on-trafficking-in-persons_html/GLOTIP_2014_full_report.pdf
  8. 2021 Trafficking in Persons Report – United States Department of State [Internet]. U.S. Department of State; 2021. Available from: https://www.state.gov/reports/2021-trafficking-in-persons-report/
  9. Macias Konstantopoulos W, Ahn R, Alpert EJ, Cafferty E, McGahan A, Williams TP, et al. An international comparative public health analysis of sex trafficking of women and girls in eight cities: Achieving a more effective health sector response. J Urban Health. 2013. PMID: 24151086
  10. Calhoun C. Push and pull factors. Oxford Dictionary. Soc Sci Oxford Univ Press. 2002;
  11. Walls NE, Bell S. Correlates of engaging in survival sex among homeless youth and young adults. J Sex Res. 2011. PMID: 20799134
  12. PEARR Tool Trauma-Informed Approach to Victim Assistance in Health Care Settings. Dignity Health, in partnership with HEAL Trafficking and Pacific Survivor Center. 2019.
  13. Identifying Victims of Human Trafficking: What to look for in a healthcare setting. National Human Trafficking Resource Center. The Polaris Project.
  14. Tracy EE, Konstantopoulos WMI. Human trafficking: A call for heightened awareness and advocacy by obstetrician-gynecologists. Obstet Gynecol. 2012. PMID: 22525917
  15. Meshkovska B, Siegel M, Stutterheim SE, Bos AER. Female sex trafficking: Conceptual issues, current debates, and future directions. J Sex Res. 2015. PMID: 25897567
  16. Zimmerman C BR. Caring for Trafficked Persons: Guidance for Health Providers. Health Providers. Geneva, Switzerland: International Organization for Migration. 2009.

By |2024-04-16T18:33:41-07:00Jan 29, 2022|Emergency Medicine, Expert Peer Review (Non-Clinical), Psychiatry|
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How I Work Smarter: Al’ai Alvarez MD

One word that best describes how you work?

Compassion

Current mobile device

iPhone 12

Computer

MacBook Pro

What is something you are working on now?

Where do I begin? The pandemic has opened doors for virtual talks and conferences, so I’m just taking it week by week sometimes. I’m also doing a fellowship, the Stanford Byers Center for Biodesign Faculty Fellowship. I’m learning how to apply design thinking to well-being interventions in the ED, and hopefully collaborating with other high-performance teams. I am also co-directing a conference in May 2022 on High-Performance Resuscitation Teams.

How did you come up with this Idea/Project?

re: High-Performance Resuscitation Teams Conference, I have been attending the Mission Critical Teams Institute summits over the past several years. We wanted to create a conference focused on healthcare and high-performance teams. I’ve had the opportunity to center my areas of interests in Medical Education, Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion) through human-centered design. A natural area was focusing on team performance and professionalism under stress.

What’s your office workspace setup like?

I’m in the middle of 5 people-office space. I have a plant, some snacks, and a big monitor. I haven’t been there in months. My home office is somewhat similar.

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

Paper and pen writing of big deadlines in a week. I’ve tried calendaring after learning from Dr. Jennifer Kanapicki, though I have yet to develop the discipline to do this weekly. My coach offered an alternative, which is focusing on 3 big projects a week to focus my energy. This helps me put things in perspective, as opposed to having so many loose ends, and writing it down cognitively frees up memory space for me.

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

Quick run-through in the morning, and start deleting.

What apps do you use to keep yourself organized?

On Chrome: OneTab for all my tabs. Omnifocus for my to-do stuff. My calendar is a part of my life so my calendar is an extension of my brain. When2meet to find mutual availability for meetings plus My calendar with zoom links.

How do you stay up to date with resources?

Twitter. I know.

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

Eyeball patients immediately so I have a sense of who’s sick and who’s not. Talk to the nurses. They know more about the patient most of the time. For the rest, I follow the mantra, “Quality care takes time,” and I am on the faster end of the dispositions in my group, as I’ve learned to be more comfortable with managing uncertainties.

ED charting: Macros or no macros?

No macros. I also don’t chart as much as I should. I write for the sake of documenting and not for billing. I’m OK with that. We can’t do it all.

Advice

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

    #selfcompassion. Can’t do everything perfectly. Show up. Learn to say no. The power of perspectives. In 1 week, 1 month, 1 year, 10 years will this really matter? This grounds me on how I tackle tasks and often the emotions surrounding deadlines.

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

    Easier said than done, practicing self-compassion has allowed me to really develop a growth mindset. To start, simply doing a daily mindfulness practice of even 5-10 minutes. This trains my mind to slow things down when things become chaotic. This also trains me to be attuned to how my body reacts to stress, and therefore, tending to it whenever I notice these sensations (neck stiffening up, etc).

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

    I may be doing a ton of stuff, and in the background, I’m doing a ton more and failing. For me, the more things I’m working on that I’m truly passionate about, the more I get done. I’m OK with failure, and whenever I do (and not if I do), these offer me a great opportunity to learn how to be better (or choose better opportunities). Last and also very important, I find the collaborations bring more meaning to my work.

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

By |2022-01-18T09:55:16-08:00Jan 21, 2022|How I Work Smarter, Medical Education|
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IDEA Series: Escape the Snake Room

IDEA series snake room

The Problem

A snakebite from a venomous snake can result in a potentially life-threatening toxin-mediated disease (1). The WHO considers snakebites to be an important occupational disease in Southeast Asia (2). Particularly in rural areas of Pakistan, snakebites represent a common public health concern. The relatively rare nature of this condition in urban environments, however, limits exposure to it by emergency medicine (EM) residents. Thus, additional focused training is necessary to prepare EM physicians to manage snakebites in a timely and effective manner. 

The Innovation

The “Snake Room” gamification-based, timed activity teaches and assesses clinical practice essentials in the management of snakebites among EM residents. 

The Learners

The target learners were EM residents of all class years, although a similar instructional model could be applied for teaching other uncommon diseases in under-resourced settings to any relevant learner group.

Group Size

Snake Room requires 4 total facilitators (1 facilitator per station for 4 stations). Each facilitator supervises 5-7 participants in each group during the time they attempt the station, for a total of up to 28 participants and 4 facilitators. 

Equipment

This activity utilizes simple and readily available materials, including the following:

  • WHO manual of snakebite management (3): The manual is a comprehensive guide for snakebite management specifically in Southeast Asia. The manual provides management strategies for low-resource settings of relevance to rural areas of our country. The stations were therefore developed in accordance with this reference.
  • Online stopwatch: An online stopwatch was projected on a large screen. A 15-minute timer was started at the beginning of the activity for each group, and was reset before the entry of the next group. 
  • Laptops and speakers: In 2 of the sub-stations, a computer was utilized to display PowerPoint slides as a part of the activity. For example, participants had to view images on the slides and rapidly identify different grades of snake bites, as well as differentiate images of venomous snake bites from other bites (i.e., rodent bites) that patients may present in rural areas. The slides automatically cycled after every 30 seconds. The speakers played snake charmer music in order to create an auditory distraction for the participants to mimic the distracting environment of the ED. 
  • Materials for low-fidelity wound simulation: 
    • Red slime to mimic features of myonecrosis 
    • Clear occlusive dressings to hold the red slime in place
    • Red, orange, and yellow dry pastel to demarcate inflammation around the bite wound
    • Manikin to demonstrate the bite marks on the lower limb

Description of the Innovation

The “Snake Room” activity took place over a 3-hour period. Four groups consisting of 5-7 members participated. There were 4 stations with 4-5 sub-stations in each station. Each station incorporated gamification and competitive-learning methodology. The substations featured clinical cases, image identification, puzzles, finding the right answer card hidden in the room, and/or low-fidelity wound simulation.

Each group of participants included residents from each class year in order to mimic the team composition most commonly encountered in our clinical environment, where senior level residents supervise a team of junior residents. The activity organizers intentionally formed teams with uniformity in academic and clinical skills to create a level playing field.

Before the start of each station, facilitators also provided a briefing to the group of participants regarding the task and amount of time available to complete it. A projector displayed the time. Groups had 15 minutes to complete each station, and each group attended the stations in the sequential order. Group members had the option to utilize online and/or in-print resources in addition to recall to complete the tasks. 

Effective use of technology was assessed. One of the groups used the Google scan app to identify the key word and obtain the answer to the puzzle.

During the activity, the course director and facilitators actively assessed participant performance as they attempted to work through the stations utilizing a questionnaire with Likert scales measuring the following:

  • Knowledge of snakebite management
  • Problem-solving
  • Leadership skills
  • Communication among team members
  • Allocation of roles among team members
  • Utilization of technology (i.e., mobile devices)
  • Understanding of the task
  • Ability to finish the activity on time
IDEA series snake room completed tasks
Successful completion of the tasks and escape from the Snake Room

The group that completed all of the puzzles and stations successfully in the allotted amount of time and achieved the highest score on the assessments of leadership, task delegation, and communication skills won the competition. 

IDEA Snake Room debrief
Debriefing session with one of the groups

At the conclusion of the activity, participants completed an evaluation form to provide feedback about the activity to the faculty organizers. Participants also received feedback during a debrief session, where faculty identified gaps in knowledge and skills and provided suggestions for how to translate lessons learned to future clinical performance. Later that day, the winning group was announced and each group’s feedback was shared in a single email to all participants, allowing groups to compare their performance. 

Materials for the activity are available upon request by contacting Dr. Shahan at [email protected].

Lessons Learned

  1. The activity allowed faculty to assess core EM skills apart from medical knowledge, such as leadership and communication. EM residents had the opportunity to practice navigating team dynamics, and working in a group within a safe learning environment facilitated collegiality among junior and senior residents.
  2. The faculty who planned the activity sought feedback from participants to optimize future iterations through short-mini interviews with group participants at the end of the activity.
  3. The assessment questionnaire was developed according to local considerations and may warrant adjustment depending on the institution and location in which the activity occurs. Internal and external validation of the assessment tool is in process. 
  4. Substations require careful, intentional planning such that they focus on an isolated aspect of the main theme, such as presentation of the disease or diagnostic test interpretation. 
  5. We incorporated audio distractions to mimic the challenges inherent to the ED environment, where residents must commonly navigate complex clinical scenarios as a team amidst frequent interruptions and competing demands. Visual distractions could also be incorporated. 
  6. Simulations (low- or high-fidelity) can be introduced while planning these sessions, but it should align with the intended learning outcomes and must be appropriately timed to maintain gamification principles. 
  7. The Snake Room activity was well received by EM residents, who requested additional iterations of this activity adapted to other topics. Participants shared their general impression that this activity offers a fun, unique educational experience with a team-based approach. 

Theory behind the innovation

We successfully combined competitive-learning theory with gamification in the Snake Room didactic to result in a positive, impactful educational experience for learners (4). Teaming participants in small groups encouraged collaboration and co-construction of new knowledge in a social constructivist approach. 

Interested in reading more innovations in education?

Read other Ideas in Didactics and Educational Activities (IDEA) series posts on ALiEM.

References

  1. Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: a review. PLoS neglected tropical diseases. 2010;4(1):e603. PMID: 20126271
  2. Warrell DA. Guidelines for the management of snake-bites. Guidelines for the management of snake-bites. 2010. (https://apps.who.int/iris/handle/10665/204464) 
  3. World Health Organization. Guidelines for the clinical management of snake bites in the South-east Asia region. 2005.
  4. Robson K, Plangger K, Kietzmann JH, McCarthy I, Pitt L. Is it all a game? Understanding the principles of gamification. Business horizons. 2015;58(4):411-20.
By |2022-01-05T18:56:35-08:00Jan 6, 2022|IDEA series, Medical Education|
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