asynchronous emsThe novel coronavirus pandemic (COVID-19) resulted in the cancellation of educational experiences for emergency medicine (EM) residents at many institutions, including emergency medical services (EMS) ambulance ride alongs. The Accreditation for the Council of Graduate Medical Education (ACGME) requires that residents have educational experiences related to EMS, emergency preparedness, and disaster medicine. EMS experiences must include ground unit runs, direct medical oversight, and participation in multi-casualty incident drills [1]. There are few dedicated EMS curricula published in the literature, and those in existence incorporate physical ride-alongs [2].

Name of Innovation

We sought a virtual method of continuing residency education related to EMS in order to maintain normalcy, consistency, and a sense of community during a time of physical isolation. We recognized that replicating the traditional EMS rotation, based largely on experiential learning, was impossible in a virtual format. Instead, we elected to focus on asynchronous activities intended to expand resident knowledge of prehospital and disaster medicine. We utilized Google Classroom as a central repository for educational materials. The rotation culminated in the completion of a reflective assignment.

Learners targeted

Target learners consisted of emergency medicine interns at the Thomas Jefferson University Hospital whose EMS rotations were canceled due to COVID-19.

Detailed description of the activity

Historically, the intern EMS rotation consisted fully of experiential learning. The first week was spent participating in ride-alongs and observation at the 911 call center with the Philadelphia Fire Department. Learners reported a variable experience influenced greatly by time of year, patient volume, and pre-hospital providers. The creation of the virtual curriculum in response to COVID-19 provided an opportunity to focus on several areas.

Social connection & EM foundational knowledge

To maintain a social connection with peers, all residents with canceled rotations participated in virtual “homeschooling,” run by our faculty and senior residents. Residents and faculty met several times a week to review a homegrown “back to basics” core content curriculum via ZOOM video conference.

EMS foundational knowledge

To supplement core content reviews provided by the virtual “back to basics” curriculum, we also delivered an EMS-focused asynchronous curriculum. We developed a Google classroom that served as a repository of:

      • Evidence-based literature: We included evidence-based articles specifically focused on utilization of backboards, field termination, and other prehospital resuscitation protocols.
      • Procedural videos: We featured EMS-relevant procedures including supraglottic airways, intraosseous placement, and double sequential defibrillation. We used existing resources available through the EMRAP podcast. Residents were required to review all videos/procedural information as well as select 3-4 pieces of curated supplemental FOAMed resources for their personal knowledge.
      • EMS protocols: We included both institution- and city-specific protocols, such as the “scoop and run” strategy unique to the Philadelphia police department.
      • Educational modules: In order to review key concepts in disaster medicine, residents completed the free on-line FEMA modules for certificates in National Incident Management Systems (ICS100, ICS700). They were given the option to complete additional modules in lieu of reviewing FOAMed/EBM articles if desired.

EMS experiential learning

To provide a substitute for “ride along” activities, we featured two free, open-access documentary series available on YouTube:  “Boston EMS” and “Air Ambulance ER.” These unscripted documentaries were broadcasted television series in 2015-2016. They demonstrate real cases and the lives of both Boston EMS crews and the British Emergency Medical Helicopter Service. We intended to incorporate virtual case discussions with local EMS providers and our institutional critical care transport team via ZOOM, but have not yet implemented these due to the current clinical demands on our EMS providers that have limited their ability to participate.

Reflective assignment

Upon completion of the rotation, residents completed a reflective assignment that required them to respond to 6 narrative questions. Questions focused on ED and EMS provider communication and evaluating the effectiveness of departmental protocols. These questions related specifically to our department quality improvement goals of improving EMS to ED provider hand-offs and evaluating the perceived effectiveness of several of our protocols. Residents responded to these questions via the Google classroom site.

asynchronous ems

Figure 1: This screenshot demonstrates the content included in the Google classroom set-up for the asynchronous EMS curriculum. The curriculum is available to be shared upon request to the author.

Lessons learned

  • Learners received this approach well and remained engaged in learning the basics of pre-hospital and disaster medicine. Those who have participated thus far recommend continuing this in the future, as an adjunct to ride-alongs.
  • This method of education promoted social connection through the residency virtual “homeschooling” opportunity, but also helped maintain a desired sense of normalcy by continuing core residency education despite the ongoing pandemic.
  • We would have appreciated additional oversight of learners in order to perform more robust learner assessment and program evaluation.
  • Some of the content may have been too advanced for the typical PGY-1 emergency medicine resident. In the future, we will consider organizing material by level of training.

Future planning

As physical distancing limitations remain in place, we are planning a virtual simulated multi-casualty event utilizing Zoom video conferencing software with multiple co-hosts and a series of breakout rooms.

When feasible, our EMS rotation will again incorporate experiential ride-alongs, but will now also be supplemented with our asynchronous curriculum in order to provide a comprehensive educational experience in prehospital and disaster medicine.

References

  1. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/110_EmergencyMedicine_2019.pdf?ver=2019-06-25-082649-063 (Accessed May 8, 2020).
  2. Mancera M, et al. A Model Curriculum for an Emergency Medical Services (EMS) Rotation for Emergency Medicine Residents. JETem. 2018;3(1):C23-45. https://doi.org/10.21980/J8DD0F

 

 

 

Megan Stobart-Gallagher, DO

Megan Stobart-Gallagher, DO

Assistant Residency Program Director
Assistant Professor of Emergency Medicine
Department of Emergency Medicine
Einstein Healthcare Network
Philadelphia, PA
Megan Stobart-Gallagher, DO

@megsahokie

EM doc. APD with @JeffEMRes. Einstein trained... where I became the original #badassdoctormomtweets are my own and not medical advice!