Work in progress: How can you balance ED crowding and education?

I’m working on writing a CORD consensus article on the impact of ED crowding on education and innovations towards maintaining educational excellence. We posited 2 scenarios of ED crowding:

Overwhelming numbers of active ED patients
Many ED boarders who are awaiting inpatient beds and who are taking up rooms which normally would have been used to see new patients

What approaches do you know of which improve the ED educational experience for learners? We have thus far categorized innovations into 3 areas:

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By Michelle Lin, MD|2016-11-11T19:01:30-08:00Mar 23, 2010|Medical Education|

Article review: The next 10 years in medical education

“Medical Education in the United States and Canada in 1910” was a landmark article, published by Abraham Flexner (shown in photo) in 1910. It’s commonly referred to as the Flexner Report. It revolutionized medical education in its call for higher quality and standardization.

In summary the report advocated for the improvement of medical education and medical schools in 4 areas:

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By Michelle Lin, MD|2016-11-11T19:01:30-08:00Mar 22, 2010|Education Articles, Medical Education|

Work in progress: Poster on blogging

I need your help with a project!

My poster on blogging was accepted to the annual UCSF Academy of Medical Educator’s Education Day. Feelings of joy and validation were quickly followed by terror and inadequacy.

In order to get my poster costs reimbursed, I have to get feedback from my co-authors and incorporate that feedback into the poster. As you can see from the poster title on top, I have no co-authors! Since you are all my virtual co-authors, I thought I’d solicit for comments and suggestions.

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By Michelle Lin, MD|2017-03-05T14:18:34-08:00Mar 16, 2010|Medical Education, Social Media & Tech|

Article review: ED crowding and education

“The effect of ED crowding on education”

My heart almost stopped when I read this article title in Amer J of Emerg Med. This was the premise of my recently completed study – using a prospective, time-motion methodology. I’m in the process of writing the manuscript. Did I get scooped by my friends at U Penn?

Whew. Fortunately, no. Different methodology.

This study was a cross-sectional study looking at learner assessment of education, using a validated tool called the ER (Emergency Rotation) Score. The results are interesting.

The problem

We know that ED crowding negatively impacts clinical care. How does it impact our teaching of medical students and residents? The ED is traditionally known as a great place for learning how to resuscitate high-acuity patients, to manage and risk-stratify undifferentiated cases, and to perform procedures. Experientially, I feel like I teach less when it gets extremely crowded.

Methodology

Over a 5-week period, 43 residents and 3 medical students prospectively assessed 34 attendings using a simple ER Score tool. There were 352 separate encounters. This validated tool assessed the attending based on 4 domains (teaching, clinical care, approachability, helpfulness) with each domain assessed on a 5-point scale. The scores were correlated with crowding measures (waiting room number, occupancy rate, number of admitted patients, and patient-hours).

ER Score tool

What was their enrollment scheme?

Upon arrival, the research assistant selected the patient with the most recent admission order where the learner-attending pair was still present in the ED. The learner was asked to fill out the ER Score tool. For each admitted patient case, the research assistant also enrolled a non-admitted patient with a similar triage intake time. The learner for this non-admitted case was also asked to fill out the ER Score tool. The study group intentionally structured this methodology to oversample admitted patients, which they assumed impacted education more than non-admitted patients.

Results

The median score was 16 of 20. ED crowding levels were NOT associated with ER scores or their individual domains.

How fascinating that learners still felt that the quality of teaching and learning in the ED was maintained despite the ED being overwhelmed beyond capacity.

The next step is to follow Kirkpatrick’s model in conducting educational research. In this model, satisfaction/reaction-based studies are the first (lowest) tier. Such studies inherently have flaws based on bias, recall, and halo effect. The next study is to look at more objective measures assessing the impact of crowding on education. Hmm, I better get going on my manuscript.

Kirkpatrick’s 4-tiered model to evaluate training and education

Reference
Pines JM, Prabhu A, McCusker CM, Hollander JE. The effect of ED crowding on education. Amer J Emerg Med (2010) 28, 217–220.

By Michelle Lin, MD|2016-11-11T19:01:31-08:00Mar 15, 2010|Education Articles, Medical Education|

Article review: SAEM Tests

This is is a great look back at how SAEM Tests were developed and now used by EM clerkships across the country. Because EM does not have a National Board of Medical Examiners shelf exam, a tremendous effort was made by the authors to create a set of validated questions for clerkship directors to use.

Specifically point serial correlation coefficients (range -1 to +1) were calculated for each question. A high coefficient means a high correlation between the performance on the individual test question and the performance on the overall test. After rewriting 25% of the test questions because of poor correlation coefficients, all current test questions now have a point serial correlation coefficient >0.2. (more…)

By Michelle Lin, MD|2016-11-11T18:43:23-08:00Mar 1, 2010|Education Articles, Medical Education|

Hot off the press: Free EM Practice articles

Thanks to EB Medicine, “Emergency Medicine Practice” articles from 2007 and earlier are now free! This series is a well-written and practical evidence-based review resource for EM physicians. It’s a great place to start reading about bread-and-butter EM content, especially for medical students and junior residents. There haven’t been too much change in the past 3 years on many of the topics.

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By Michelle Lin, MD|2016-11-11T19:01:34-08:00Feb 25, 2010|Medical Education|

Trick of the trade: Spicing up your evidence-based lecture

Before I start creating a new talk, I ask myself 3 questions:

Who will be in the audience?
How can I make my talk more worthwhile to audience members, beyond their just reading the material/handout/articles on their own?
Am I giving a talk before or after Dr. Amal Mattu? If so, just be resigned to being second-best.

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By Michelle Lin, MD|2019-02-19T18:55:41-08:00Feb 24, 2010|Medical Education, Tricks of the Trade|