Tiny Tip: Determining capacity in an emergency – The CURVES Mnemonic

Determining capacity in a patient that needs to make an emergency medical decision can be a huge challenge for emergency physicians with substantial legal and patient-oriented consequences. As emergency medicine providers we need to be able to make this determination confidently and decisively. By preparing our approach in advance we can be more confident in our decisions.

In November 2014, EM:RAP (check it out!) had a great segment on decision making capacity and covered the article:

Chow, G. V., Czarny, M. J., Hughes, M. T., & Carrese, J. A. (2010). CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting. CHEST Journal, 137(2), 421-427.

It provides a concise, applicable approach using the CURVES mnemonic

C – Choose and Communicate – Can the patient make and communicate a choice without coercion?
U – Understand – Does the patient understand the risks, benefits, alternatives, and consequences of their decision?
R – Reason – Is the patient able to reason and provide logical explanations for their decision?
V – Values – Is the decision consistent with the patient’s values?
E – Emergency – Is there a serious or imminent risk to the patient’s well-being?
S – Surrogate – Is there a surrogate decision maker available?

The first four letters (CURV) assess whether or not the patient has decision-making capacity. A patient can be considered to have capacity in a given situation if they can communicate their decision, demonstrate their understanding of their situation, and show that they have a reasonable thought process that is consistent with their values. The final two letters (ES) determine whether treatment can proceed with implied consent in a patient lacking capacity. Treating with implied consent is only appropriate when the patient does not have capacity to make the decision (CURV), it is an emergency, AND there is no surrogate decision maker available.

Notably, the articles stresses that capacity is not an all-or-none phenomenon and can change both over time and depending on the decision under consideration. For example, an inebriated trauma patient may have capacity to decide to accept or decline pain medication but not have the capacity to consent or reject a life-saving surgical intervention.

What do you think of the CURVES mnemonic? As outlined in the referenced article, there are many other ways to assess consent – how do you assess capacity in your emergency department?

Peer reviewed by Teresa Chan (@TChanMD)

Author information

Brent Thoma
Editor in Chief at BoringEM
Emergency Medicine Resident at the University of Saskatchewan, wannabe Medical Educator, Blogging Geek. + Brent Thoma

The post Tiny Tip: Determining capacity in an emergency – The CURVES Mnemonic appeared first on BoringEM and was written by Brent Thoma.

KT Bite: Comparison of the Canadian CT Head Rule and the New Orleans Criteria

Editor’s note: This is a series based on work done by three physicians (Patrick ArchambaultTim Chaplin, and our BoringEM Managing editor Teresa Chan)  for the Canadian National Review Course (NRC). You can read a description of this course here.

The NRC brings EM residents from across the Canada together in their final year for a crash course on everything emergency medicine. Since we are a specialty with heavy allegiance to the tenets of Evidence-Based Medicine, we thought we would serially release the biggest, baddest papers in EM to help the PGY5s in their studying via a spaced-repetition technique. And, since we’re giving this to them, we figured we might as well share those appraisals with the #FOAMed community! We have kept much of the material as drop downs so that you can quiz yourself on the studies.

Paper: Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury

Citation: 
Stiell, I. G., Clement, C. M., Rowe, B. H., Schull, M. J., Brison, R., Cass, D., … & Wells, G. A. (2005). Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. Jama294(12), 1511-1518.  doi:10.1001/jama.294.12.1511.

Nickname of study: 
n/a

Summarized by: Patrick Archambault
Reviewed by: Teresa Chan & Tim Chaplin

Clinical Question

Compare the clinical performance of the Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) decision rules for detecting the need for neurosurgical intervention and clinically important brain injury. See decision rules here.

PopulationInclusions:
Blunt trauma with LOC, amnesia, disorientation
GCS 13+
Injury within 24 hours

Exclusions:
<16 years old
Minimal head injury
Penetrating injury, depressed skull fracture, focial neurological deficits, unstable vitals
Seizure
Bleeding disorder or anticoagulants
Pregnant
InterventionApplication of CDR
ControlCT head or Outcome measure at 14 days without headache absent or mild, no complaints of memory or concentration problems, no seizure or focal motor findings, and returned to normal daily activities
OutcomeNeed for neurosurgical intervention or clinically important brain injury on CT

Methods

This is a validation and a head-to-head comparison of the previously derived rules.

Prospective cohort study in 9 Canadian ED with a 1822 patients. Both clinical decision rules were applied to patients and compared to the gold standard CT. Patients were assessed by residents or ED physicians trained with a one hour lecture and reported on standardized forms. Some independent assessments were done to assess interobserver agreement.

Results

8 patients (0.4%) required neurosurgical intervention and 97 (5.3%) had clinically important brain injury.

PREDICTING NEED FOR NEUROSURGICAL INTERVENTION

  • The NOC and the CCHR both had 100% sensitivity
  • CCHR was more specific (76.3% vs 12.1%, P<.001)

PREDICTING CLINICALLY IMPORTANT BRAIN INJURY

  • the CCHR and the NOC had 100% sensitivity
  • the CCHR was more specific (50.6% vs 12.7%, P<.001)

REDUCING NEED FOR CT

  • CCHR= 52.1% would require CT vs NOC=88.0%  would require CT (P<.001).

INTER-RATER RELIABILITY

  • The kappa values for physician interpretation of the rules, CCHR vs NOC, were 0.85 vs 0.47.

Conclusions

CCHR and NOC are both highly sensitive rules for ruling out significant head injuries. The CCHR has higher specificity and therefore reduces the number of CT scans ordered relative to the NOC.

Take Home Point

The Canadian CT Head Rule is a highly sensitive tool for ruling out significant head injuries.

EBM Considerations

There was the possibility of familiarity bias affecting the results that would favor the CCHR since this study was performed in Canada. Not ALL patients in the study underwent CT. Some eligible patients were not enrolled as enrollment required voluntary assessment and completion of forms by ED physicians, possibly resulting in selection bias. Some patients were lost to follow up.

To download a copy of this summary click here NRC – BoringEM – Canadian Head CT.

Author information

Eve Purdy
Medical Student Editor at BoringEM
Fourth year medical student at Queen's University-happily consuming, sharing, creating and researching #FOAMed

The post KT Bite: Comparison of the Canadian CT Head Rule and the New Orleans Criteria appeared first on BoringEM and was written by Eve Purdy.

Finding a Mentor in Emergency Medicine

As a junior student with a budding interest in Emergency Medicine, I recently realized I was missing a crucial component for building a successful EM career: a mentor.

A mentor may provide a protégé with career advice, research and networking opportunities, personal guidance, and perhaps a strong CaRMS reference letter. A number of physicians I admire have told me they attribute much of their career success to strong mentorship received as students, residents, and even as staff physicians.

“Heck, having a mentor sounds pretty sweet! How can I get one?”

This is probably the thought that crosses the minds of most medical students when they learn about the benefits of mentorship. Yet, despite the integration of mentorship programs into medical school curricula, most students continue to say they do not have a mentor, even though they would like to have one.

Why do students lack mentors?

The literature on mentorship describes the qualities of a successful mentor-mentee relationship, desired characteristics for each role, and even topics of discussion for regular meetings. What is missing is advice on practical issues, such as where to meet staff physicians and how to approach them about the “M” word, especially without appearing like an insufferable “gunner”. I believe this lack of practical guidance prevents many students from entering into mentoring relationships.

Introductions

Since no mentoring relationship can begin without a mentor, the following is my personally-tested way of finding a physician who may fit the role.

Let your mentor come to you – Start with the Emergency Medicine Interest Group at your school. If there isn’t one where you are doing your training, consider starting one. An interest group is a great place to meet a new EM doctor each week and learn about their specialty, interests, and personal attributes. Don’t be discouraged if you are unable to ask about personal life or mentorship as this point, especially since your peers will likely surround the doctor as soon as the formal talk is over. In a way, approaching attending EM physicians is like approaching attractive girls: they are rarely alone, have very short attention spans, and are always in a rush. Use this opportunity, however, to introduce yourself and express interest in an observership with that doctor. A more in-depth personal discussion can occur later in a more private setting.

The direct approach – Another approach to meeting EM physicians is to directly look up faculty members and ask them for a short meeting or observership, especially if you have an area of interest that matches theirs. Most staff are receptive to medical students’ emails and answer quickly. At the very least, they may refer you to someone who is more available or better matches your interests. Approaching staff after Grand, Research, or Resuscitation Rounds is another option, as there will be fewer students speaking to the doctor once the meeting is done. Be aware, however, that the physician may soon be rushing off to work or speaking with his peers and prepare any questions with brevity in mind.

Approach anxiety – Use Twitter to learn about the field of medical education and EM. I was amazed at the number of prominent leaders on Twitter, their willingness to casually respond to questions, and their readiness to share opportunities. Once you find someone whose opinions or work you like, contact them. Like email, Twitter can be a great tool because it gives you time to think about what to ask and how to respond. Unlike email, however, you won’t have to worry about whether your note ended up in the junk folder or whether someone will have time to read your message. Once you’ve established rapport, you can propose a Skype meeting or project that the two of you could work on together.

A word of caution - When you reach out to a potential mentor for the first time and they agree to speak with you, especially if they have never met you before or are in a position of leadership, make additional efforts to use their time appropriately. You can ask any clerk, resident, or doctor about daily aspects of a specialty, why they chose that path, positive and negative aspects of their job, and so on. However, if you are contacting someone for a specific reason, such as wanting to work on a project under their guidance, for example, make this the primary goal of your interaction and communicate it to that person quickly. Then show them what you have to offer.

Step outside your comfort zone – Be proactive. EM is a competitive specialty, and asking for help, whether from peers or superiors, can make all the difference. Realize that most staff in academic institutions are there because they genuinely like to teach and guide students.

Building Rapport

Once you have made contact, the first step to building more than a superficial relationship with a potential mentor is to speak with that physician privately. The benefit of doing this during an observership is that you get to see how the doctor interacts with patients and colleagues, and whether he or she is someone you want to emulate. The disadvantage is that, especially in the ED, you may not have the time or opportunity to ask questions outside of patient care. Nevertheless, you can usually bring up these questions or suggest an additional meeting after your observership, when you are thanking the doctor in person or by email.

I believe another reason students fail to find mentors is that they approach only Program Directors or Department Chairs, likely because letters of recommendation from these figures are highly valued for CaRMS. Yet, these people are often the least able or willing to take on new mentees due to other time commitments, an excessive number of students contacting them, or their current number of mentees. While their endorsement might be invaluable for CaRMS, asking for a few shifts with them during your rotation is very different from asking them to be your mentor. Remember that one of the most valuable assets of a mentor is the mentor’s availability!

On the other hand, more junior doctors are often eager to share their knowledge and experience. Their advice regarding career choices and applications can be especially useful since they are closer to the process than their more senior colleagues. These more junior staff are often more approachable, but may be just as busy as senior staff while establishing themselves professionally. Additionally, they may not have as much influence over the resident selection process as senior staff.

Final thoughts

Focus on finding a role model: look for someone you get along with and admire personally and professionally. If you respect them, chances are others do too. Try to choose someone who will help you understand more about your future field and career goals; this should be the main objective of having a mentor, rather than finding someone who you believe will write an influential reference letter.

In the end, the journey to finding a mentor is a personal one, but I hope these tips, which have worked for me, are simple and practical enough to get you started.

Peer reviewed by Dr. S. Luckett-Gatopoulos (@SLuckettG).

Peer review by S. Luckett-Gatopoulos(@SLuckettG)

Sarah Luckett-Gatopoulos is a PGY1 at McMaster University’s Royal College Emergency Medicine Program.  She is also a Resident Editor for BoringEM.org.

I’d like to add a few tips of my own.

1. Be open.

As a junior resident, I embrace the opportunity to mentor near-peers. Though I’m only a year ahead of those who just clicked ‘submit’ and sent their CaRMS applications out into the world, I still have something to offer junior and senior medical students. When the ED is not busy, it can be a lot of fun to sit with a student and discuss their approach to the chest x-ray, but it’s also enjoyable to chat about residency and career choices. I have spent a fair amount of time this year talking with emergency medicine hopefuls in person and over Skype, and editing personal letters for CaRMS.

Unfortunately, sometimes med students are not open to residents, preferring to focus their time on staff physicians, and especially program directors. Residents can be a great resource, so don’t shut the door to near-peer mentorship. It’s true that we won’t be providing you with reference letters, but we can tell you a lot about residency and will happily introduce you to staff physicians if we can identify your common interests.

2. Broaden your search.

I have benefited from extensive mentoring throughout my undergraduate and graduate degrees, and also through medical school and the beginning of residency. Yet, I don’t have someone I would consider my emergency medicine mentor.

I was fortunate to be mentored by an incredible neuro-anatomist during my undergraduate degree, and we still keep in touch via long emails (often with pictures of our travels and major events in our lives). I also had the great fortune to work with a wonderful clinical case manager while I was engaged in research. She and I continued our mentoring relationship as I graduated from a data monkey to research assistant, to psychoeducational tester, and onward. Neither of these fantastic women worked in emergency medicine, but both have provided me with invaluable guidance, especially during difficult periods and transitions in my medical life.

I was also fortunate to participate in the fantastic mentorship program that is part of the curriculum at my medical school at Queen’s University. This program brings together staff and students, and though the staff group leaders were not emergency medicine physicians, they were able to provide great insight into the medical life, which guided me in my choices. Do I think an emergency medicine mentor would be a great addition to my robust network? Absolutely. But I’d encourage you to look around; sometimes mentorship is found well outside your specialty of interest.

3. Be genuine.

Nothing is more endearing than talking to someone with a genuine interest in the specialty you love. Canned questions and obvious angling are irritating. Just be yourself and you’ll find people who share your interests and want to help you along the way.

All of this is written from the perspective of a lowly junior resident, but stay tuned…maybe we’ll here from some staff physicians soon!

Author information

Gerhard Dashi
Gerhard Dashi
Gerhard Dashi is a second year medical student at Queen’s University with growing interests in Emergency Medicine, mentorship, interprofessional teamwork, and #FOAMed.

The post Finding a Mentor in Emergency Medicine appeared first on BoringEM and was written by Gerhard Dashi.

KT Evidence Bites: TTM

Editor’s note: This is a series based on work done by three physicians (Patrick ArchambaultTim Chaplin, and our BoringEM Managing editor Teresa Chan)  for the Canadian National Review Course (NRC). You can read a description of this course here.

The NRC brings EM residents from across the Canada together in their final year for a crash course on everything emergency medicine. Since we are a specialty with heavy allegiance to the tenets of Evidence-Based Medicine, we thought we would serially release the biggest, baddest papers in EM to help the PGY5s in their studying via a spaced-repetition technique. And, since we’re giving this to them, we figured we might as well share those appraisals with the #FOAMed community! We have kept much of the material as drop downs so that you can quiz yourself on the studies.

Paper: Targeted temperature management at 33°C versus 36°C after cardiac arrest

Citation:
Nielsen N, Wettersley J, Cronberg T, Erlinge D, Gasche Y, Hassager C et al.. N Engl J Med. 2013 Dec 5;369(23):2197-206.  Epub 2013 Nov 17.  doi: 10.1056/NEJMoa1310519.

Nickname of study:
TTM

Summarized by: Teresa Chan
Reviewed by: Patrick Archambault & Tim Chaplin

Clinical Question

Does cooling people to 33 degrees after cardiac arrest result in better outcomes (mortality and neurological) than 36 degrees?

PopulationUnconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause
InterventionTargeted temperature of 33 degrees C
ControlTargeted temperature of 36 degrees C
Outcome1) All Cause Mortality

2) Composite of poor neurologic outcome and death using cerebral performance score (CPC) and modified Rankin Score (mRS)

Methods

RCT: Multicentre Randomized Controlled trial, 939 patients included in analysis

Results

ALL CAUSE MORTALITY

  • 50% of pts in 33 degree group died vs. 48% of pts in 36 degree group
  • Hazard ratio 1.06 (95% CI 0.89-1.28); P=0.51

POOR NEUROLOGIC FUNCTION OR DEATH

  • CPC: 54% of pts in 33 degree group died or had poor neurologic outcome per the CPC vs. 52% of pts in 36 degree group
    • Risk ratio 1.02 (95% CI 0.88-1.16); P=0.78
  • Modified Rankin: 52% of pts died or had poor neurologic per the mRS
    • Risk Ratio 1.01 (95% CI 0.89-1.14; P=0.87)

Conclusions

The study states that: “In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C.” However, this is a slight overreach because the superiority design only powered the study to find an 11% absolute reduction in mortality.

Take Home Point

Cooling post-arrest patients (of cardiac cause) to temperatures of 33 degrees was not found to be superior to cooling them to 36 degrees.

EBM Considerations

Some clinicians are interpreting the results by concluding that the ‘absence of fever’ is the key concept that results in benefit for post-arrest patients. That said, this paper did not show that inference, but showed that there are not a large differences in mortality and/or neurologic outcomes between patients ‘controlled’ to a target temperature of 33 vs. 36 degrees. Notably, invasive cooling devises were still used in the 36°C group and if a patient was cooler than the target temperatures upon randomization the team did not actively warm them.

To download a copy of this summary click here (NRC – BoringEM – TTM summary download).

Note: This post was amended on November 27th to clarify that the study showed a lack of superiority between the two arms of the TTM study.

Author information

Eve Purdy
Medical Student Editor at BoringEM
Fourth year medical student at Queen's University-happily consuming, sharing, creating and researching #FOAMed

The post KT Evidence Bites: TTM appeared first on BoringEM and was written by Eve Purdy.

Counterpoint: SHPOS…we haven’t heard of it

This Counterpoint is an open letter from a group of Canadian learners and physicians that was written in response to a recent National Post Article (How a SHPOS is born: What doctors call their very worst patients) which described a phrase  the author suggested is “commonly” used in medicine.  Our work was submitted as a letter to the editor in response to the article but we have not received any correspondence from the National Post. We are publishing this on a number of Canadian medical blogs because we feel that sharing our perspective is necessary with the hopes of continuing a more thoughtful, balanced dialogue of language in medicine. 

Dear Editor,

We read with horror the recent article “How a SHPOS is born: What doctors call their very worst patients” by Anne Skomorowsky dated November 10, 2014.

We were appalled that the author conveyed the impression that this offensive term, SHPOS, is common and used by the general medical community. The opening line “A medical acronym, SHPOS, helps a doctor summarize a patient’s history in just five letters” implies that the term “a doctor” would include a large number of practicing physicians.

This is false.

This article has sparked discussions over several social media platforms and in the hallways of our hospitals. The consensus from our investigation is that the majority have never used, nor heard of this disgraceful and offensive term. Physicians and learners spanning many generations (medical students to experienced physicians of greater than 20 years) and specialties (emergency medicine, internist, surgeons) agree that that the SHPOS term is completely foreign. The term is as uncomfortable to us as it is the intended readership. On digging a bit deeper (as a result of this article), it seems this term may have been used in the past, in the early 80s or before but given the unfamiliarity of currently practicing physicians, it is unlikely that it is used with any frequency today (1,2). Thus, to taint all current doctors with this archaic and unused term is a reckless overreach at best and slanderous at worst. In fact, the journalistic ethics of reintroducing such a horrible term back into the current lexicon is both irresponsible and dangerous. Language evolves over time, and most of the time with good cause, because terms like SHPOS are eliminated because of their inherent problems.

As a community we do recognize that the language physicians choose is important and appreciate that in many instances we might do better. We have explored issues around language in medicine through an international and open-access case study that can be accessed at one of the world’s pre-eminent medical education blogs (3). We would encourage readers interested in the use of slang by medical professionals to read this much more up to date, balanced and thoughtful exploration of the important topic. This document incorporated patient, allied health, and physician voices all together to generate a very robust discussion and handout for young physicians to read and better understand the importance of words in clinical practice.

Sadly, the information in this article was likely not verified among the health care professionals to whom it refers. Unfortunately, the message conveyed to the readership of the National Post and general public is that terms like “SHPOS” are commonplace and accepted among the medical community, and this supposition is largely unverified in Canada too – especially since it is merely a repurposing of a previously featured article from an American magazine. Acknowledging that slang and language are contextual, and cultural, the National Post might have been better served to do their own, contextually relevant, investigation into this issue, rather than simply feature the article of an American author.

We do not use the term SHPOS. The thesis of the article is simply untrue. This article potentially biases and inflicts pre-arrival damage to future doctor-patient encounters, creating barriers and potentially interferes with the relationship developed by current health care staff and the people they wish to help.

We urge your newspaper to consider the ramifications of posting such inaccurate and potentially damaging materials in the future.

Elisha Targonsky, MD, CCFP-EM

Eve Purdy, BHSc, MD Candidate

Teresa Chan, HBSc, BEd, MD, FRCPC, MHPE Candidate

Swapnil Hiremath, MD, MPH

Heather Murray, MD, MSc, FRCPC

Ross Morton MD, FRCP, FRCPC, FACP

 

References

  1. Strauss A. (1983). Shpos. South Med J; 76 (8): 981-4.PMID: 6879294
  2. Schwartz H. (1980). A person is a person an shpos is not. Man and Medicine; 5(3): 226-8.  PMID: 7242156
  3. Murray H .(2014). Academic Life in Emergency Medicine, MedICs Cases “Case of the Backroom Blunder”

 

Author information

Eve Purdy
Medical Student Editor at BoringEM
Fourth year medical student at Queen's University-happily consuming, sharing, creating and researching #FOAMed

The post Counterpoint: SHPOS…we haven’t heard of it appeared first on BoringEM and was written by Eve Purdy.

BoringEM: We Need Your help – Digital Scholarship Elective

Digital Scholarship & the Scholarship of Teaching

Editor’s note: Alia Dharamsi is a PGY1 from the University of Toronto. She will be completing the first ever Digital Scholarship Elective with myself (Dr. Teresa Chan) & Dr. Andrew Petrosoniak this December.  The following is a write up by Alia that describes her intended experience, and then we have a small favour to ask of you at the end…. (SPOILER: She has as short survey you can help her complete… CLICK HERE TO GO TO THE SURVEY.)

– Teresa Chan

The Question:
As social media garners more momentum in the realm of medical education, how can I as an Emergency Medicine Resident learn how to teach effectively online?

Background:
What is the role of Social Media in Emergency Medical Education?

Digital media has become the next frontier in medical education, and has grown exponentially over the past few years as new technologies in knowledge translation become available. Recently, a study of 226 Emergency Medicine residents demonstrated that 98% of those interviewed used some form of social media for learning, including blogs, podcasts, vodcasts, Twitter, and Google Hangouts (Scott, 2014). Additionally, a study done in the USA showed that Emergency Medicine residents prefer listening to podcasts (70%), over reading textbooks (54.3%), for their learning (Mallin, 2014).

The idea of “asynchronous education”—that learners can use recent patient encounters or prompts to guide their supplemental reading and learning—is garnering more and more attention. Asynchronous education allows a variety of modalities of teaching, including peer-to-peer learning, which are student centered, and shown to be not only preferred by learners, but also more effective (Mallin, 2014). Although new to the medical education world, asynchronous education has been adopted into other educational sectors to great success. The Khan Academy is arguably one of the most successful applications of digital technologies to advance personalized education, in the model of the “flipped classroom.” As described by Prober et. al.(2013), the flipped classroom employs digital technologies to allow students to watch vodcasts (online videos) on their own time, as many times as needed to achieve mastery, then utilize classroom time to apply said learning. To that effect, these technologies are providing residents with resources to personalize their clinical learning, and achieve mastery on their own time, can create a flipped-classroom type experience on the wards and in the Emergency Department, as with the guidance of clinician teachers they would be able to apply their knowledge to patient care. (Prober, 2013)

The Plan: A Digital Scholarship Elective

This Digital Scholarship block provides me with an opportunity to explore the fundamentals of curriculum design, in the context of my existing interests in social media and digital educational resources. Using antibiotic choices as a theme (a self-identified area of clinical weakness), I am spending one month developing a mini-curriculum on common presentations of infection to the ED, and an approach to antibiotic choices.

For this project, I will be moving through the 6 steps of curriculum development, as defined by Kern et al.:

  1. Problem identification and general needs assessment
  2. Needs assessment for targeted learners
  3. Goals and Objectives
  4. Educational strategies
  5. Implementation
  6. Evaluation and feedback

Through this elective I will be able to better understand medical education and the process of curriculum development, as well as hopefully create some resources around antibiotic choices in the ED that fellow learners will find useful.

The Product: Social Media based curriculum on antibiotic choices in the ED

Designed for the medical student and junior resident level, this curriculum will be predominantly online-based, including short chalk talks, blog posts and pocket cards on 5 common outpatient infectious disease presentations to the ED:

  1. Community acquired pneumonia
  2. UTI
  3. STI
  4. Skin and soft tissue infections
  5. Diabetic foot

Hosted on BoringEM.org, where the majority of viewers are learners in Emergency Medicine, I will be able to receive peer review and feedback on these resources once they are posted.

References

Cadogan M, Thoma B, Chan TM, et al. Emerg Med J Published Online First: [ 04 September 2014] doi:10.1136/emermed-2013-203502.

Kern DE, et al. Curriculum Development for Medical Education- A Six-Step Approach. Baltimore. Johns Hopkins University Press. 1998.

Mallin, Mike, Sarah Schlein, Shaneen Doctor, Susan Stroud, Matthew Dawson, and Megan Fix. “A Survey of the Current Utilization of Asynchronous Education Among Emergency Medicine Residents in the United States.” Academic Medicine 89.4 (2014): 598-601. Web.

Prober, Charles G., and Salman Khan. “Medical Education Reimagined.” Academic Medicine 88.10 (2013): 1407-410. Web.

Scott KR, Hsu CH, Johnson NJ, Mamtani M, Conlon LW, DeRoos FJ. “Integration of Social Media in Emergency Medicine Residency Curriculum.” Annals of Emergency Medicine (2014): n. pag. Web.

Thoma, B., Chan, T., Desouza, N., & Lin, M. (2013). Implementing peer review at an emergency medicine blog: bridging the gap between educators and clinical experts. CJEM, 16, 21-24.

How you can help:

Alia Dharamsi is a PGY1 in Emergency Medicine at the University of Toronto, conducting a quality improvement project with BoringEM on the application of social media technologies to resident learning. This project has been granted REB exemption from the Hamilton Integrated REB (HIREB).

She is exploring resident comfort, knowledge around antibiotic choices, and their usage resources to guide choice of antibiotics at the bedside.

The main objective is to understand current patterns of use of resources to learn about antibiotic choices before, after, and during an ED shift, and then see if social media learning materials (e.g. #FOAMed) has a role in filling knowledge gaps for learners.

This survey is SHORT (5 minutes), anonymous, and voluntary. She is specifically interested in answers from junior residents (R1, R2), and CC4s.

CLICK HERE TO GO TO THE SURVEY.

Please feel free to share with your residency program.

Author information

Alia Dharamsi
Alia Dharamsi

The post BoringEM: We Need Your help – Digital Scholarship Elective appeared first on BoringEM and was written by Alia Dharamsi.