Chandra S, Papanagnou D, Hollander J/Thomas Jefferson University, ... residents need a basic knowledge foundation on which to put these skills into practice. ... rotation that serves to enhance co-resident education and promote a just culture ...
Research Forum Abstracts pneumothorax, the resident may choose to US the patient’s lungs, which will demonstrate a lack of lung sliding. However, the resident may also choose to evaluate the patient’s gallbladder, which will reveal a normal exam. The simulator will force the resident to not only select which US exams are pertinent to the patient’s presentation, but also to differentiate normal from pathologic findings on the exams displayed. After the resident submits an answer, the program will display whether it was correct or incorrect and then provide a brief explanation of the disease process and associated US findings. When the module is completed, the simulator will calculate statistics on how the resident performed which his or her US director may use to assess their US knowledge. Conclusion: We created an assessment measure of EUS trainee knowledge, application of indications, image interpretation and medical decisionmaking. The pilot of this project will be centered around the common clinical presentation of shortness of breath and chest pain. Future work will expand to other presenting signs and symptoms as well.
TF13
Telehealth Facilitator Certificate Program
Chandra S, Papanagnou D, Hollander J/Thomas Jefferson University, Philadelphia, PA
Study Objective: Healthcare organizations, practitioners, and patients are increasingly recognizing the value of telehealth (TH) and its benefits. TH has the potential to broaden access to health care, increase efficiency while reducing costs, and enhance patient safety, quality of care, patient satisfaction, and health outcomes. Professional and faculty development in TH is critical in order to effectively and appropriately train providers to deliver and facilitate health care through TH. However, formalized training in TH is underdeveloped. In response to this need, a Telehealth Facilitator Program was designed at Thomas Jefferson University. This program provides comprehensive knowledge on the tools required to facilitate TH encounters for providers interested in enhancing their skillset within this domain. The goal of the program is to prepare participants for a role in TH facilitation as part of the inter-professional health care team. Upon completion of the program, learners will be able to: 1) compare and contrast TH and standard health care delivery, 2) define the applications, benefits and challenges of TH delivery, 3) recognize the role of the TH facilitator within the interprofessional team, 4) employ common TH technologies with technical and operational proficiency, 5) describe general troubleshooting tips during TH encounters for network, connection and audiovisual issues and 6) identify the ethical, legal, and regulatory considerations of TH. Methods: The program consists of five self-directed, online learning modules that run over the course of 5 weeks. The modules are offered on a Jefferson-developed, cloud-based system, iCE (Interactive Curricula Experience). iCE encourages learners to be self-directed, and provided multiple resources they can navigate at their own pace. An introductory module (Module 0) helps familiarize learners with the iCE platform. The five modules include: 1) An Introduction to Telehealth: Introduces TH as a mode for health care delivery, and explains the role of a TH facilitator; 2) Expansion of Telehealth: Describes the different types of TH delivery and its challenges; 3) Settings of Telehealth Delivery: Describes the applications of TH for inpatient and outpatient settings; 4) Troubleshooting in Telehealth: Engages the learner to anticipate and troubleshoot technological challenges of a TH encounter and 5) Essence of Coordination: Explores the legal and ethical considerations of TH. Learners participate in weekly synchronous sessions at the end of each module with content discussion by a faculty moderator. Learners also participate in weekly asynchronous discussions on SLACK©, a cloud-based team collaboration tool. Course facilitators provide written formative feedback based on learners’ participation. There are multiple choice question assessments at the end of each module, which participants are required to successfully pass in order to move on to the next module. Conclusion: This course will provide TH facilitator training in response to the predicted growing market for new roles with this emerging and increasingly utilized modality for health delivery. Through this online modular series, learners will develop the skillset to successfully facilitate, evaluate, and advocate for TH at their organizations.
TF14
Procedural Sedation Competency for Emergency Medicine Residents
Spangler R/University of Maryland School of Medicine, Baltimore, MD
Introduction: The use of various procedural sedation techniques has a wide range of applications is a core competency for United States emergency medicine training
Volume 68, no. 4s : October 2016
programs. After graduation, trainees are required to have the skills necessary to sedate a patient for fracture care, wound care, and other minor surgical procedures done at the bedside in the emergency department. In order to master these skills and techniques, residents need a basic knowledge foundation on which to put these skills into practice. A cohesive, organized module, with measurable proficiency that is designed for emergency medicine residents can help provide this knowledge, allowing hands-on application of the skills in a safe and more effective environment. Study Objectives: After participating in this module the emergency medicine resident should be able to perform all the basic steps necessary for a safe patient sedation. This includes the following; 1. Appropriate applications of definitions and terminology as it pertains to procedural sedation. 2. Describe the steps needed to prepare for a safe sedation. 3. Apply appropriate monitoring techniques for sedation. 4. Choose an appropriate medication based on procedure and patient characteristics. 5. Explain appropriate discharge instructions for a safe patient discharge after sedation. Methods: The learner will first complete a pre-test, to establish a baseline knowledge level for means of comparison after completion of the module. The modules itself is set up in a self-guided fashion, allowing the learner to easily navigate back and forth to re-read, review, or even skip sections depending on their prior comfort level. The resident will complete the module at his or her own pace, then will complete a post-test, to assess their retention and overall understanding of the material provided. The post-test will serve as a measurement to determine if the resident has achieved an appropriate baseline knowledge level in order to perform procedural sedation in the emergency department. Conclusion: After completion of this competency module, the resident learner will have gained a functional understanding of the steps taken to ensure safe procedural sedation in the emergency department. This includes understanding of a select group of commonly used medications, monitoring equipment, and appropriate preparation for sedation, as well as discharge after sedation. The overall competency of the resident can be measured by a post-test assessing their retention of information.
TF15
Lessons Learned: A Quality Improvement Curriculum
Nguyen V/UCLA, Los Angeles, CA
Study Objectives: This curriculum has been developed to target emergency medicine residents in accordance with the ACGME requirements to integrate residents and have them actively participate in interdisciplinary clinical quality improvement (QI) and patient safety (PS) programs. With the advent of the quality movement, it is imperative that emergency medicine residents develop a core understanding of quality care, patient safety, and quality improvement. It is also of utmost importance to transform the culture of medicine and create a safe environment in which to discuss medical errors and near misses in order to improve patient care and promote valueadded delivery of medical care. This curriculum’s purpose is to enhance the emergency medicine resident’s understanding of quality improvement through formal didactic lectures, case reviews, and through transforming the medical culture in the emergency department. After participation in this curriculum, the emergency medicine resident will be able to 1) explain and apply the principles of just culture, 2) identify system failures and opportunities for systems improvement through case-based audit of 72-hour return admissions, and 3) conduct a fishbone analysis and root cause analysis (RCA) that highlights a medical error, adverse event or near miss with goal to identify opportunities for systems improvement during a lessons learned lecture during the senior administrative rotation that serves to enhance co-resident education and promote a just culture. Methods: This is a longitudinal curriculum over the 4-year residency program. There are two formal lectures defining just culture as well as how to perform a fishbone analysis and RCA. A weekly case review of 72-hour admissions will be conducted by residents to identify quality issues related to patient care, systems of care, care processes, and care transitions in order to enhance patient care and provider education. A formal lessons learned lecture integrating case review, fishbone analysis and RCA, will be created by senior residents as a means to evaluate resident understanding and application of principles taught. The lecture will highlight key quality improvement concepts. Resident understanding will be assessed via case review and senior lessons learned presentation. Conclusion: This formalized curriculum will enhance emergency medicine residents’ participation in QI through formal didactic education and integrated review of cases. The curriculum also provides a framework for transforming into a just culture in which to improve patient safety and medical delivery of care. Development of additional lectures, formal implementation and evaluation of case reviews and lessons learned is still needed to understand the effectiveness of this curriculum.
Annals of Emergency Medicine S155
