Faculty Bibliography

Background: High-fidelity simulation is increasingly being used as a medical educational tool and research modality. Currently, there are no universally accepted metrics for evaluating clinician performance in the simulation environment. Furthermore, there are no baseline data characterizing the expected performance on specific cases according to training level. Objectives: The objective of this pilot study is to develop a set of six ACLS-based cases and compare clinician performance using three different evaluation metrics. A secondary objective is to compare case performance between PGY-1 and PGY-3 EM residents. Methods: Six cases with critical actions were developed by a multiinstitutional EM faculty group. Each of the cases was piloted by 25 residents at the lead institution (13 PGY-1s and 12 PGY-3s) in random order. Sessions were videotaped for independent review by two faculty observers. Data included the total number of critical actions (CA) achieved, time to each critical action (TCA), and a previously validated clinical performance evaluation (CPE) score. The CPE score is comprised of eight criteria, each with an eight-point possible score, with 8 being "excellent" and a 1 being "poor". The reported case scores are the average of the eight values. Descriptive statistics, Wilcoxon rank sum tests, and repeated measures analyses of variance using generalized estimating equations are reported. Results: For all of the cases, the mean proportion of CAs performed was 0.94 by the PGY-1s and 0.91 by the PGY-3s (p>0.05). For TCA, 11 CAs were analyzed and only two were found to have a significant difference: the PGY-1s had a time to second defibrillation attempt of 236 seconds compared with 291 seconds for the PGY-3s, and the PGY-3s had a time to epinephrine of 112 seconds compared to 164 for the PGY- 1s (p<0.05). The overall mean CPE scores were 5.72 for PGY-1s and 6.38 for PGY-3s (p<0.05). The mean difference in CPE scores between the faculty observers was -0.39 (95%CI -0.55 to -0.23). Mean pro!

Introduction: The chaotic nature of many shifts in the emergency department makes the incorporation of quality, evidence-based education and nuanced academic debate a herculean task. Additionally, the practice of emergency medicine (EM) varies greatly between and within departments. Our goal was to promote relevant, enjoyable, and succinct faculty teaching during clinical shifts. Methods: We developed a monthly set of questions centered on a controversial area in EM. These questions are sent to faculty and residents. Faculty members receive relevant articles and citations to aid them in reviewing in advance of that month's topic. Posters (please see example) are prominently displayed in all clinical areas, and residents are encouraged to ask their attending physicians and senior residents that month's questions. Although all the questions pertain to a specific topic, they also function in a "stand-alone" fashion permitting brief mini-lessons intercalated into the functioning of a department. Results: This curriculum encourages residents to think critically about differing approaches to clinical problems in our field, hear various viewpoints, and examine the evidence behind their teachers' practices. At the end of the month, "answers" are published, and discussed in our weekly conference. The answers are based on a review of the best available literature. During the summer of 2011, this method evolved into a (Figure presented) web page, http://www.emlyceum.com. The questions, and monthly posters, are distributed for free to subscribers to the web page, as are the "answers," with hypertext links to the literature, at the end of each month. Discussion: Critical debate with master clinicians on controversial management issues represents an underused educational mode for residents and medical students. To that end, we have created a novel curriculum and presentation method to promote discussion on various EM topics and to encourage residents to investigate the evidence basis and rationale for how they care for patients

Background: Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease, with a high associated morbidity. Although tubo-ovarian abscess is not a rare entity, its diagnosis presents multiple challenges. Prior literature has suggested that pelvic ultrasound is now the 'gold standard' in the diagnosis of tubo-ovarian abscess. Objective: Given the increasing use of ultrasound in the emergency department, it is important to understand the diagnostic value of transvaginal ultrasound in ruling in and ruling out important gynecologic emergencies. Our objective is to review the literature to evaluate the sensitivity and specificity of ultrasound in the diagnosis of tubo-ovarian abscess. Case Report: We review a case of a 31-year-old woman with frank peritonitis caused by a tubo-ovarian abscess diagnosed by contrast-enhanced computed tomography after an initial negative transvaginal ultrasound. Conclusion: We found evidence for lower sensitivity and specificity of ultrasound for the diagnosis of tubo-ovarian abscess than generally reported in the emergency medicine literature