Showing posts with label cdem. Show all posts
Showing posts with label cdem. Show all posts

Top 10 tips to building a productive academic team




I have been meaning to share this list of great tips about building a productive academic team. Major projects often require an interdisciplinary team of experts who are equally motivated towards a shared goal. I was recently at the 2012 Society of Academic Emergency Medicine where Dr. William McGaghie gave an inspiring CDEM keynote speech. He has been on a myriad of successful academic teams and he shared with us his top 10 list of pearls for team-building.



William C. McGaghie, PhD
  • Jacob R. Suker, MD, Professor of Medical Education
  • Professor of Preventive Medicine
  • Director of Evaluation, Northwestern University Clinical and Translational Sciences (NUCATS) Institute
  • Northwestern University Feinberg School of Medicine Center for Education in Medicine

I am in the process of building a big academic team myself, comprising of rheumatologists, software engineers, instructional design experts, and an education research expert. This list came in quite handy for me and so I thought I'd share.

The team should have:
  1. Shared goals—common mission & vision
  2. Functional diversity (everyone should have different defined roles)
  3. Clear leadership—may change or rotate
  4. Shared mental models & language
  5. High standards, recognition, & credit
  6. Sustained hard work / commitment
  7. Physical proximity
  8. Minimize status differences within the team
  9. Maximize status of the team
  10. Shared activities that breed trust
While these tips may seem obvious, they are a worthwhile reminder nonetheless. Dr. McGaghie shared examples where different members took the lead on different manuscripts within the overarching project and that everyone's opinions were valued. I found it interesting that he felt that physical proximity contributed to the success of his projects. In-person meetings and check-ins seem to have provided added value.

Article review: Inconvenient truths about effective teaching


At the CDEM meeting during the SAEM national meeting this past week, the keynote speaker (Dr. Charles Hatem from Harvard) mentioned a great editorial article called "Inconvenient Truths About Effective Clinical Teaching."

Here's a summary of the opinion article from Lancet:

Clinician-educators are increasingly pressured to do more with less time and support (i.e. release from clinical responsibilities). Learners are the victims of this calculated move.

The author talks about 8 habits to emulate as an educator, in the setting of these changing times. This is especially helpful to review as we are about to start a new academic year with fresh interns and medical students in the Emergency Department.

1. Think out loud.
  • This lets learners understand our thought-processes as we apply population-based research to our individual patient. This translational process is often ambiguous with lots of gray areas. Understanding our clinical reasoning process, rather than just the end result of ordering particular tests or treatments, is an invaluable lesson for learners.
  • "If our profession is serious about lifelong learning, we must recognise that learning can’t happen without humility. Teachers who humbly think out loud help to show the way."
2. Activate the learner.
  • "Experts agree that adult education is a tango: it takes two. The dance will fail, no matter how expert the teacher, if the learner is not actively, even passionately, engaged."
  • The most effective teachers use the democratic style, where learners are encouraged to think and act autonomously in real-time. The trick is to "activate" learner initiative while "protecting them from themselves" to avoid errors. 
  • With time pressures, it's easy to fall back to an autocratic approach (do what the teacher says). It's a constant struggle to employ a democratic style of teaching. In reality in the ED, we teach using a hybrid approach - sometimes autocratic, sometimes democratic.
3. Listen smart.
  • Great patient care is all about taking a good history. Similarly, great clinical teaching is all about listening to the learner. What's his/her knowledge base, how is his/her clinical reasoning skills, and does s/he see the big picture?
  • Assessing a learner's presentations and discussions often requires that you (as the educator) independently talk to the patients to ensure that the facts are correct.
4. Keep it simple.
  • Learners are constantly learning and processing various information when working clinically.  Boiling down complex medical issues to a few simple teaching points can be difficult for the educator, but it is most effective for the learner. 
  • Also, I find that you don't have to unload all of your knowledge on the learner. Pick 1-2 concise teaching points targeted to the level of the learner and focus on them.  
5. Wear gloves.
  • This is critical. Put on gloves and go to the patient's bedside. Having a learner see your approach to bedside care, empathy, and communication are invaluable. We often take for granted the art of patient care and we can best teach it by demonstrating to others.
6. Adapt enthusiastically.
  • Things rarely go exactly as planned on a shift. Instead of fearing surprises, use these unexpected occurrences (eg. patient clinical deterioriation, medication side effect) as teaching opportunities.
7. Link learning to caring.
  • Teach about empathy and professionalism. 
  • Patient care involves actually caring about the individual patient. Patients are more than just about their disease. 
  • "Understand the patient's illness as well as their disease." 
8. Kindle kindness.
  • Patients can sense genuine kindness and caring. Be a role model in how you talk with patients. There is a difference between indifferent politeness and genuine kindness.
  • Learners are more receptive to feedback when spoken with kindness, no matter how critical your comments are. For me, I picture myself as a coach in (rather than an evaluator of) their lifelong learning process, and frame their feedback accordingly. 

Reference
Reilly BM. Inconvenient truths about effective clinical teaching. Lancet. 2007; 370(9588): 705-11. PMID: 17720022
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SAEM has a new website


The Society for Academic Emergency Medicine (SAEM) has totally revamped its website into a really spiffy and professional looking site. I belong to the SAEM Web Editorial Board Committee and got to work with some really inspiring physicians and administrative staff who were able to launch this year-long project. Congrats team!


Peak into the CORD Academic Assembly: A first-hand account


Be a fly on the wall!

March 3rd kicks off the 3-day CORD Academic Assembly in San Diego where educators, residency directors, and clerkship directors all assemble for a big pow-wow on all-things education in EM.

Keep checking back here for real-time accounts of the conference as I bounce from room to room and lecture to lecture. The most recent post will be at the top.



FYI, Dr. Horng emailed me the link to his CORD handout from the "Web 2.0" didactic session. Thanks!

Hot off the press: Nominate someone for a CDEM award

CDEM was born here.

In its third official year, the Clerkship Directors in Emergency Medicine (CDEM) organization is still growing strong. It all started with six of us at an informal dinner in Boston about 5 years ago. And now the organization has grown so large that it is now for the first time offering annual awards to its members.

Know an award-worthy educator? Nominate him or her!



CDEM Clerkship Director of the Year Award
This award recognizes an Emergency Medicine Clerkship Director that has made significant contributions to either a 3rd or 4th year EM rotation. To be eligible for this award, the nominee must currently be a Clerkship Director of a mandatory, selective or elective rotation and have served in that role for a minimum of 5 years. This award is presented at the annual CDEM meeting.

CDEM Young Educator of the Year Award 
This award recognizes a medical student educator at the Clinical Instructor or Assistant Professor level and less than 10 year from residency completion who has made significant contributions to teaching and educating medical students.  This award is presented at the annual CDEM meeting.

CDEM Distinguished Educator Award 
This award recognizes a medical student educator at the Associate Professor or Professor level who has made significant contributions to and has demonstrated sustained excellence in teaching and educating medical students for 10 or more years. This award is not presented annually; rather, it is bestowed on special occasions.

CDEM Award for Innovation in Medical Education
This award recognizes a medical student educator at any faculty rank who has made a significant and innovative contribution to undergraduate medical education. This award is presented at the annual CDEM meeting.

Deadline: Mon, March 14, 2011.

Instructions on how to nominate someone for a CDEM Award can be found at the CDEM/SAEM Website.

EMRAP Education Podcast: Educational Resources in EM


Dr. Rob Rogers has posted his 21st podcast on EMRAP Educator's Edition. The topic is "Educational Resources in Emergency Medicine".

Listen to why you need to know about these resources:

Upcoming Conferences:
Authors:
Websites:
  • TED Talks
  • Academic Life in Emergency Medicine ... Hey wait! Cool. That's me! Thanks for the shout out, Rob.
  • ERCast - Podcast interviews hosted by Dr. Rob Orman (free)
  • EMCrit - Podcast summaries by Dr. Scott Weingart on critical care topics (free)
  • EMRAP Critical Care Edition - Podcast with Dr. Michael Winters, Dr. Peter DeBlieux, and Dr. Rob Rodriguez ($60 annual subscription)
  • EMCast - Monthly podcast interviews with Dr. Amal Mattu through Emedhome.com ($99 annual subscription)
  • CDEM Curriculum - Resource put together by CDEM for medical students which includes essentially an online textbook in EM (free). Rob even put in a plug for my Digital Instruction in Emergency Medicine (DIEM) online simulation cases. I'm not actually done with all the cases, as Rob suggests! Only the first case on Chest Pain is done thus far... Ack! I better get crackin' now.
Spend a high-yield 25 minutes listening to Rob's take on need-to-know educational resources in EM.

New guest-blogger: Dr. Rahul Patwari

Welcome to new superstar guest blogger, 
Dr. Rahul Patwari

He is an Assistant Professor of Emergency Medicine and Clerkship Director at Rush University Medical Center in Chicago, IL. Rahul has led the charge in building CDEM's educational site at www.cdemcurriculum.org, which essentially is a free online textbook for students on their EM rotation. His amazing technological saavy and passion for education in EM make him a perfect fit on our blogging team. I've been begging him to join us for over a year. We're lucky to have him!

Wednesday's post is his first (of hopefully many).

Article review: Selected abstracts from 2010 CORD Academic Assembly (pt 2 of 3)


In the 2010 CORD-CDEM Supplement in Academic Emergency Medicine, 29 abstracts were selected from the CORD Academic Assembly. I reviewed the Abstracts #1-10 last week. Here's a quick look at Abstracts #11-19. Maybe there's something that you might be interested in pursuing or reading more about. Personally, I love reading about what educational studies are ongoing on out there.

‘‘Are They Who They Say They Are?’’ New Behavioral-Based Interview Style 
Robert E. Thaxton, Robert J. Kacpowicz, John Rayfield (Wilford Hall Medical Center, USUHS and San Antonio Military EM Residency)

In this 2-year retrospective review of 32 residents to an EM program, 3 residents required disciplinary action. These 3 residents scored only 2.93 (on a scale of 1-10 with 10 being the best) on a behavioral-based scoresheet, which was based on a bank of standardized interview questions on leadership, motivation, flexibility, interpersonal skills, and decision making. Scoresheets were completed by faculty interviewers when these residents interviewed at their program. In contrast, the other 29 residents scored an average of 8.19. The authors conclude that professional behavior may be quantified and predicted by this interview approach.

Resident Values: Are They Important?
Robert E. Thaxton, John Rayfield (Wilford Hall Medical Center, USUHS and San Antonio Military EM Residency)

This 3-year retrospective study attempted to correlate resident disciplinary action with their interview question "Why is Medicine as a career important to you?"This interview was conducted upon entering the residency program by an APD. Responses were classified as either internal/personal focus or external/others focus. Of the 11 residents (of 78) who received disciplinary action, 8 had an internal focus and 3 had an external focus. Interestingly of the 8 with an internal focus, the disciplinary action involved areas of professionalism. Of the 3 with an external focus, the disciplinary action involved areas of medical knowledge (2) and professionalism (1).

Physician Perceptions of the Effect of Implementing a Standardized Written Plus Verbal Patient Sign-Out Process in an Academic Emergency Department 
Jason D. Heiner, Jason M. Desadier, Benjamin P. Harrison (Madigan Army Medical Center)

This survey study using a convenience sample of 31 participants (21 EM residents and 10 EM staff) studied their opinions of a combined verbal AND written sign-out process (i.e. handoff) in the ED. After implementation of the new sign-out process, 81% felt that the sign-out process was somewhat better or much better and 61% felt that their comfort with the sign-out plan was somewhat better of much better.

‘I Want a Real Doctor’’: The Effects of Physicians in Training on Patient Satisfaction in the Pediatric Emergency Department
Brian W. Walsh, Alex Troncosco (Morristown (NJ) Memorial Hospital)

This multicenter, 5-year, retrospective study looking at Press Ganey surveys at 4 pediatric EDs evaluated patient satisfaction scores for when a physician in training (student/resident) was present and absent. Results from 1,373 ED visits revealed that doctor satisfaction was very slightly lower (87.9 vs 86.4, mean difference 1.5, 95% CI 1.3 to 1.7) with a physician-in-training. Oddly, the likelihood that the patient would return was higher (85.4 vs 84.4, mean difference -1.0, 95% CI -1.7 to -1.3) with a physician-in-training. In the end, although these differences are statistically significant, they are very slight, conflicting. Physicians-in-training probably do not tremendously affect patient satisfaction.

Does Subspecialty Training Affect Patient Satisfaction? 
Brian W. Walsh, Elizabeth Haines (Morristown (NJ) Memorial Hospital)

This multicenter, 5-year retrospective study looking at Press Ganey surveys at 4 pediatric EDs evaluated "overall satisfaction", "satisfaction with doctor" and "likelihood to return" scores for EM-trained vs Pediatric EM-trained physicians. There was no difference across all three outcome measures.

Social Networking Websites and Internet Media As Residency Recruitment Tools 
Bjorn K. Peterson, Eric J. Dahl, Cullen B. Hegarty (Regions Hospital, St. Paul, MN)

This abstract describes a program's educational innovation to harnass social media platforms to promote their residency program to potential applicants. Short video clips give viewers an overview of the program were posted on YouTube and Facebook.

Teaching Academy for Emergency Medicine Faculty 
Michael A. Bohrn, David C. Vega, Noelle A Rotondo, Rebecca I. Bluett (York PA Hospital)

This abstract describes an EM department's education innovation in faculty development. EM faculty teach other EM faculty about bedside/clinical teaching over four 2-hour small-group sessions. These sessions cover bedside teaching, feedback and evaluations, teaching portfolios, and sharing of individual teaching projects.

Advanced Competency in Electrocardiography (ACE) Program for Emergency Medicine Residents
Michael A. Bohrn, Rebecca I. Bluett (York PA Hospital)

This abstract describes a residency's educational innovation in creating a certificate program in Advanced Competency in Electrocardiography (ACE) for only the top-performing EM residents. The certificate program requires that residents complete additional monthly assignments and self-study readings about advanced concepts in ECG interpretation.

Faculty Evaluations of Emergency Medicine Residents Using an Audience Response System Michael J. Rest and Laura J. Bontempo (Yale University School of Medicine, New Haven CT)

Faculty members often evaluate residents in a non-anonymous forum amongst other faculty. One program changed its practice by collecting faculty evaluation scores at a monthly meeting by an audience-response system (ARS), which is typically used in lectures. This allows for anonymous scoring and a platform where everyone's "voice" counts. This survey-based study assessed 17 or 24 (71% survey response rate) faculty members who felt that an ARS system increased the accuracy of resident evaluations.

Clip to Evernote

Article review: Selected abstracts from 2010 CORD Academic Assembly


In the 2010 CORD-CDEM Supplement in Academic Emergency Medicine, 29 abstracts were selected from the CORD Academic Assembly. Here's a quick look at the first 10. Maybe there's something that you might be interested in pursuing or reading more about.

The Patient Experience: A Novel Educational Experience in the ACGME General Competencies
Catherine A. Marco, David F. Baehren, and Kristopher Brickman (University of Toledo, Toledo, OH)
In this retrospective survey study, 8 PGY-1 EM residents shadowed patients from triage to disposition and found positive and negative examples of the ACGME competencies - Professionalism, Systems Based Practice, Patient Care, and Interpersonal and Communication Skills.

Political Advocacy Project for Emergency Medicine Residency 
David C. Lee, Joseph LaMantia, Andrew E. Sama, and Theodore Sung (North Shore University Hospital)
The purpose of this curricular innovation was to enhance political awareness and action amongst emergency physicians. PGY-4 EM residents at the program were required to complete a political advocacy project where residents each studied a federal or local bill, summarized their findings to the EM program, and contacted their local political representative. 

Successfully Introducing Interns to Academic Medicine: A Curriculum for Participation in the Annual Society for Academic Medicine Meeting 
Jeffrey N. Love (Georgetown University/Washington Hospital Center)
This curricular innovation involved a structured experience for PGY-1 EM residents at the annual SAEM meeting, which included attending didactic sessions, select abstract presentations, and interest group meetings.  Upon their return, each resident then reported on 3 abstracts/papers at the departmental journal club.

The Effect of a Novel, Emergency Department Based Work-Study Program on Medical Students’ Perceived Skills and Clinical Competency 
M. Tyson Pillow, Shkelzen Hoxhaj, Angela Fisher, Donald Stader, and Theresa Tan (Baylor College of Medicine)
This retrospective survey study evaluated 1st year medical students who were provided the opportunity to participate in a work-study program where they learned how to perform phlebotomy, place peripheral IVs, and obtain ECGs in the ED. Eleven of the 53 respondents (21%) had participated in the work-study program. Compared to the non-participants, their comfort level on a 0-4 point scale were much better for phlebotomy (3.6 vs 0.2), IV placement (1.6 vs 0.1), and ECG acquisition (3.2 vs 0.6). 

Is Academic Productivity Amongst Emergency Physicians Affected by a Salary Incentive Plan?
Randy J. Hartman, Timothy C. Stallard, David L. Morgan, and Cindy F. Rush (Texas A&M University Health Sciences Center)
This retrospective observational study evaluated the consequence of an EM department's moving from an academic salary incentive plan (which rewarded scholarly activity, conference attendance, and completion of resident evaluations) to a clinical-based salary incentive plan (which rewarded clinical RVUs only). Results showed that the percentage of faculty submitting projects dropped by 62.5%, conference attendance decreased by 9.8%, and completed resident evaluations dropped by 24.7%.

EM-CROS: A Model for the Development of an Emergency Medicine Curriculum for Rotating Residents 
Tyler S. Jorgenson, Ian B. K. Martin, Kevin J. Biese, Cherri D. Hobgood (UNC-Chapel Hill School of Medicine)
This curricular innovation focuses on teaching off-service residents rotating in the ED. One article was selected in 7 core topics each-- chest pain, sepsis, altered mental status, shortness of breath, abdominal pain, headache, and cervical spine trauma. These articles and test questions were distributed to the residents for independent study. While on shift, the residents were encouraged to evaluate a variety of patient complaints, by having them each check off a card-based list of procedures and patient encounter objectives for the rotation period.

Medical Students’ Perceptions of an Emergency Medicine Clerkship: An Analysis of Self Assessment Surveys 
Jennifer A. Avegno, Heather Murphy-Lavoie, Lisa Moreno-Walton (Louisiana State University Health Sciences Center - New Orleans)
This 1-year survey study evaluated EM clerkship students' change in confidence level with patient management, resuscitations, oral presentations, procedural skills, and understanding of EM practice after completing an EM clerkship rotation. A secondary outcome measure was comparing these items between the 2- and 4-week clerkship groups. All of the students felt more comfortable with patient management and basic procedural skills after the EM clerkship. Students in the 2-week clerkship felt less confident in their formal presentation skills and most basic procedures (except ECG interpretation, splinting, and venipuncture) compared to those in the 4-week clerkship.

Reducing Unnecessary Administrative Time of Student Scheduling by Utilizing a Template System and Google Documents 
Jeffrey T. Van Dermark, Derek L. Kelly, and David deGive (UT Southwestern Medical Center at Dallas)
This curricular innovation empowered EM clerkship students by allowing them to select their own EM shift schedules based on a pre-templated schedule posted on Google Docs. Before the start of the rotation, students were allowed to decide amongst themselves who was assigned to each of the 10 evenly-weighted EM shift schedules. This significantly freed the administrative staff and clerkship director from burdensome administrative work to accomodate everyone's schedule requests.

Emergency Medicine Residents Exhibit Varied Learning Styles 
Nicole M. Deiorio and Donald E. Rosen (Oregon Health and Science University)
This survey-based study evaluated the learning styles of 30 EM residents based on the Kolb Learning Style Index. This self-assessment tool categorizes learners into Convergers, Divergers, Accomodators, and Assimilators. Amongst the 22 residents who responded,  59% were Convergers, 0% were Divergers, 23% were Accomodators, and 18% were Assimilators. With a variety of learning styles, the authors propose that the EM conferences and didactic curricula should be designed with this in mind.

Video Feedback to Students Can Be Easy and Inexpensive 
Nicole M. Deiorio and Ryan T. Palmer (Oregon Health and Science University)
This curricular innovation involves delivering feedback to medical students in a delayed fashion using video messaging. If real-time feedback is not possible, faculty can use a website (www.eyejot.com) to record and email their short video messages to the student for free. The authors hypothesize that subtle cues and nuances from the video format make the feedback more impactful than if done in text form.

Reference
Multiple authors. 2010 Council of Emergency Medicine Residency Directors (CORD) Selected Abstracts Acad Emerg Med. 2010. 17, Supplement: S1-S10. DOI: 10.1111/j.1553-2712.2010.00884.x
Clip to Evernote

Hot off the press: Medical Student Educator's Handbook

It's finally here! 

The second edition to the Medical Student Educator's Handbook is finished.

Here's the info from the CDEM website:

The first edition of this book, titled Medical Student Educator’s Handbook, edited by Drs. Douglas Ander, Wendy Coates, and David Manthey, was developed by the Society for Academic Emergency Medicine (SAEM) Undergraduate Medical Education Committee and Medical Student Educator’s Interest Group. In 2008, Clerkship Directors in Emergency Medicine (CDEM) was formed as an academy within SAEM. CDEM is now the national voice of emergency medicine clerkship directors and medical student educators.

This book represents the collaborative efforts of CDEM members to update the previous edition. The goal of this book is to assist EM faculty interested in medical student education in their efforts to develop a more successful emergency medicine clerkship based on highlighted best practices. This book is intended to offer the reader tools to deal with the challenges of running a successful EM clerkship, including addressing administrative and political considerations, promoting faculty, supporting faculty involvement, determining methods for evaluation, and developing novel teaching tools. We envision its use as a reference for up-to-date, practical information.

Oh, and did I mention that it's FREE!? It's a great reference for educators, chief residents, and anyone interested in academics. Congrats, Rob and Siamak (editors-in-chief).

(2 MB)

Computer simulation DIEM case goes live!


Welcome to the new age in medical education for EM!

I've been working on building these interactive, online simulation cases for CDEM for the past 2 years. Finally, the pilot case (a patient with chest pain) is finally out! EM medical students across the country are trying their hand at diagnosing and managing the patient. Preliminary data shows that the case is easy to navigate and students enjoy the ability to make decisions autonomously.

This is the first case in a series called "Digital Instruction in Emergency Medicine", or DIEM cases. These cases allow the user to navigate through a variety of patient complaints and presentations. Similar to high-fidelity simulation, these cases are dynamic, contain multimedia content, and provide a realistic approach to patient management; however in contrast, users can complete these cases anytime and anywhere. All you need is internet access and a computer with Flash capability.

The DIEM modules are especially unique in several ways:
  • There is a timer built into the cases to enhance a sense of realism.
  • Many parts of the physical exam are displayed for the user to interpret (rather than telling the user what was found).
  • When ordering laboratory tests, each test must be justified.
  • At the end of each case, the user is required to write up the Emergency Department chart. Documentation is a crucial skill, which medical students often do not get to practice enough in the age of Electronic Medical Records.
  • Similar to true simulation exercises, case debriefing is just as important as participation in the case. There is a debriefing section for each DIEM module, which includes an area for self-reflection, a discussion of Critical Actions, and the "ideal" chart writeup.'
It really helps to watch the short instructional video above to help you navigate the case. You'll need about 45-60 minutes for the whole case (if you include the chart writeup and all of the debriefing info that follows the case).

The DIEM cases will all live on the CDEM Curriculum site, which also houses the online EM textbook available for free. This was written by CDEM faculty members for the senior medical student level.

Article review: Pitfalls in writing test questions

Which is the best answer?
  • A. Yes
  • B. No
  • C. Maybe
  • D. 2 of the 3 above
  • E. None of the above
Wait, what?! 
What a terribly written test question! 

Have you encountered similarly poor questions on exams? It turns out that writing multiple-choice test questions is actually pretty difficult. There are some basic rules to follow and pitfalls to avoid.

In an article, the authors (hey, I know most of them! Wait, why wasn't I invited?!) talks about the lack of a National Board Medical Exam in Emergency Medicine. Such "shelf exams" exist in other specialties but in EM. Frankly, it has to do with how expensive it is for medical schools and clerkships to purchase these tests. Within EM, 59% of clerkships are using an end-of-clerkship exam, most of which are designed by the local institution.

The authors also provide an excellent review on the art of writing multiple-choice test questions.


So what are the basics in writing a good multiple-choice test question?

There are 2 parts to each test item:
  1. The stem: The question itself
  2. The answer choices: Keyed response (correct answer) vs Foils/Distractors (wrong answers)
The Stem
  • The test question should be clear and answerable without looking at the possible choices.
  • The test question should have only one undisputable answer.
  • Avoid being too wordy. State the question concisely.
  • Avoid "negative" questions (eg. Which of the following is NOT a cause for...)
The Answer Choices
  • There are smart test-takers out there. For instance, choices which have the word "always" or "never" are usually foils and thus incorrect answers. Grammatically incorrect choices are usually wrong. When choosing between 2 answers, the really long one is often the right choice, because the test-writer wants clarify and ensure that the answer is correct. Be aware of these when writing the keyed response and foils.
  • When listing the choices, put the responses in logical order (alphabetical or numerical).
The authors also discuss the importance of determine test reliability and content validity. Are the students performing poorly because you just suck at writing test questions? Perhaps a better solution than having all the clerkships working in isolated silos is to have a single validated exam.

Thus, the authors conclude the need for a standardized, national EM final exam, now that a formal EM curriculum has been created by CDEM this past year.

Reference
Senecal E, Askew K, Gorney B, Beeson M, Manthey D. Anatomy of a Clerkship Test. Acad Emerg Med, 2010, 17: S31-37. DOI: 10.1111/j.1553-2712.2010.00880.x
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Article review: EM in medical schools


Similar to JAMA, which publishes an annual publication focusing on Medical Education, the Academic Emergency Medicine (AEM) journal just published a AEM-CORD/CDEM supplement focusing on EM education. I was fortunate to be involved with one of the papers published in this supplement.

This paper, written on behalf of the Clerkship Directors in EM (CDEM) and the Association of Academic Chairs of EM (AACEM), reviews the past, present, and future of EM in the U.S. medical school curriculum.

EM faculty members are playing an increasingly important role in both the preclinical and clinical curriculum. Our specialty teaches skills and knowledge, crucial for all medical students regardless of their eventual career choice. EM educators are a natural fit to teaching topics, such as the following:

  • Basic life support (BLS)
  • Advanced cardiac life support (ACLS)
  • Wound care
  • Splinting
  • Basic procedural skills
  • Simulation-based education
  • Bedside ultrasonography
  • Management of common emergencies


Furthermore, as medical schools are looking towards restructuring their overall curriculum to incorporate more clinical exposure from day 1, the diverse, high-volume environment of the Emergency Department (ED) makes it a perfect fit for students. Recall back to when you were a first-year medical student. How amazing would it have been to observe ED patients to reinforce your learning about pharmacology, anatomy, pathology, and heart sounds?

From an institutional standpoint, the EM clerkship fulfills many of the Liaison Committee on Medical Education (LCME) educational requirements. The LCME is the regulatory body that accredits U.S. and Canadian medical schools. The LCME recognizes that the ED provides students with an unparalleled learning opportunity. Consequently, more and more schools are making EM clerkships mandatory. In 2004, about 39% of U.S. medical schools had mandatory EM clerkships for third-year medical students. There's an ongoing CDEM study to determine the more updated numbers (I'm guessing it'll be closer to 50%).

Medical schools are increasingly depending on the EM specialty to help with teaching students at all levels of learning. For those of us invested in medical education, this is great news.

Reference
Wald D, Lin M, Manthey D, Rogers R, Zun L, Christopher T. (2010). Emergency Medicine in the Medical School Curriculum. Academic Emergency Medicine, 17 DOI: 10.1111/j.1553-2712.2010.00896.x
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CORD Academic Assembly schedule is out!

The preliminary schedule for the upcoming 2011 CORD meeting is available to view. The theme is "Residency 2.0" -- Web 2.0 in medical education.

I downloaded and posted on Google Docs in spreadsheet format. Yours truly will be talking on March 3, 2011 in the annual session on Medical Education Journal Club, under the CDEM track. Dr. Sorabh Khandelwal and I will be reviewing the highest impact education articles from 2010 in rapid-fire form.


FYI, if you are a senior EM resident interested in academics, EMRA has a $500 "Faculty Development Scholarship for Residents" scholarship available to help fund your way there. It's the ideal learning/ networking environment with high-yield topics, big-name speakers, and just a small enough conference to actually get to meet people.

Work NOT in progress: ACEP Tricks of the Trade column


Since 2006, I have been the ACEP News columnist on "Tricks of the Trade in Emergency Medicine." Four years later, I've published and co-published 33 articles on various both low-tech and high-tech pearls.

It's official -- I'll be stepping down from the ACEP News columnist position and handing off the reins to someone with fresher ideas. Frankly, I'm running out of innovative ideas worth publishing about.

It was a tremendous opportunity for me to share some of my ideas with interested readers and I wanted to thank ACEP News, my editor at ACEP News (Terry Rudd) who fixed all my images and bad grammar, and Dr. Mary Jo Wagner (Synergy Medical Education Alliance) for trusting me to write the column.

Looking back, people have asked me how I came to be the Tricks of the Trade columnist. Like everything that I've done in academics, it's all about 50% luck and 50% hard work.

I had worked on writing a few chapters for a 2005 textbook that Mary Jo was involved in. I kept to deadlines and worked hard to make the chapters as well-written and updated as possible. Concurrently, I was building my lecturing skills by speaking at various AAEM and ACEP conferences. It was at one of these conferences at Mary Jo curbsided me and asked if I was interested in writing something for ACEP News. It would be a new column intended to help practicing emergency physicians to troubleshoot common dilemmas and obstacles in the ED, using innovative tools and approaches. The only instructions I got were -- Make it fun, make it practical, and include lots of photos.

It took me all of 2 seconds to overcome my insecurities and questions of "why me?" to jump at this awesome offer!

So if you too are looking for opportunities to get involved with various projects, I would say --
  • Keep an open mind (and ear) about interesting projects.
  • Always work hard. The quality of your work reflects directly on your skills, accountability, and reputation. Trust me -- it'll pay off in the long run.
  • Don't burn bridges. You never know how your network of colleagues may help you down the road.
  • Attend 1-2 national conferences annually. It's almost impossible to be present at these conferences and NOT get involved with meeting new people, listening to fascinating discussions, and joining collaborative endeavors.

Women in Academic EM video

As a joint project between Clerkship Directors in EM (CDEM) and the Academy for Women in Academic EM (AWAEM), there is a great 11 minute video about life in academic EM. For more information, check out AWAEM's website.



This video was filmed and edited by my friend Dr. Ernie Wang (Northshore University/ University of Chicago), who also edited the video on "Diversity in EM" in 2007. This video was a joint project between CDEM and the SAEM Diversity Interest Group.

Article Review: Revised EM Clerkship Curriculum

Last year, I was fortunate to be involved in a 1-year consensus group building exercise in revising the 2006 EM Clerkship Curriculum. Led by my friend Dr. David Manthey (Wake Forest), members of the Clerkship Directors in Emergency Medicine (CDEM) debated and went through seemingly an infinite number of drafts of the updated curriculum.

The final manuscript was just published in Academic Emergency Medicine this month.

What we came up with was the 2010 EM Clerkship Syllabus. Four goals were addressed:
  1. Refining the objectives based on the ACGME core competencies
  2. Restructuring and refining the knowledge content
  3. Writing objectives for the procedures syllabus
  4. Identifying areas of the LCME guidelines which are addressed by the syllabus
What I'd like to highlight is #2:
Restructuring the EM clerkship's knowledge content

A major goal of the revised curriculum was to allow for an EM clerkship director to more easily cover the core content material of EM within a 4-week period. This was difficult to accomplish with the overly comprehensive original curriculum from 2006.

Basically, knowledge content was categorized into three areas:
  1. Fundamental set of emergent patient presentations
  2. Set of specific disease entities, unique to EM
  3. Procedural skills
Emergent Patient Presentations
We eliminated redundant topics and content that would likely be covered in other core clerkship rotations. This resulted in 10 emergent patient presentations that all EM students should be familiar with:
  • Abdominal pain
  • Altered mental status
  • Cardiac arrest
  • Chest pain
  • Gastrointestinal bleeding
  • Headache
  • Poisoning
  • Respiratory distress
  • Shock
  • Trauma


Specific disease entities include:
1. Cardiovascular
  • Abdominal aortic aneurysm
  • Acute coronary syndrome
  • Acute heart failure
  • Aortic dissection
  • DVT / pulmonary embolism
2. Endocrine / Electrolyte
  • Hyperglycemia
  • Hyperkalemia
  • Hypoglycemia
  • Thyroid storm
3. Environmental
  • Burns / smoke inhalation
  • Envenomation
  • Heat illness
  • Hypothermia
  • Near drowning
4. Gastrointestinal
  • Appendicitis
  • Biliary disease
  • Bowel obstruction
  • Massive GI bleed
  • Mesenteric ischemia
  • Perforated viscous
5. Genito-urinary
  • Ectopic pregnancy
  • PID / TOA
  • Testicular / ovarian torsion
6. Neurologic
  • Acute stroke
  • Intracranial hemorrhage
  • Meningitis
  • Status epilepticus
7. Pulmonary
  • Asthma
  • COPD
  • Pneumonia
  • Pneumothorax
8. Psychiatric
  • Agitated patient
  • Suicidal thought/ideation
9. Sepsis


Basic Understanding of Procedural Skills
Note that for basic procedures, students need to demonstrate basic skill competency. For more advanced skills (joint relocation, endotracheal intubation, FAST ultrasonography in trauma), students need to demonstrate a basic understanding of the skill.
  • Peripheral Access
  • Airway Management
  • Arrhythmia Management
  • NG tube placement
  • Foley catheterization
  • Dislocations and Splinting
  • Incision and Drainage
  • Trauma Management
  • Wound Care
For more specifics, download the article and the 3 online supplements which detail the entire EM clerkship curriculum.

Hot off the press
Preliminary online "chapters" of the emergent patient presentations and specific disease entities, which follow this 2010 EM clerkship syllabus template, can be found on CDEM's curriculum website: www.cdemcurriculum.org. This site may become the free, go-to online textbook for EM clerkship students. This site will also eventually host my online DIEM (Digital Instruction in Emergency Medicine) cases, which were indirectly referenced in this article as adjunctive "online interactive learning modules".


Reference
Manthey, D., Ander, D., Gordon, D., Morrissey, T., Sherman, S., Smith, M., Rimple, D., Thibodeau, L., & , . (2010). Emergency Medicine Clerkship Curriculum: An Update and Revision Academic Emergency Medicine, 17 (6), 638-643 DOI: 10.1111/j.1553-2712.2010.00750.x

SAEM 2010 (June 2-6, 2010)


The Society of Academic Emergency Medicine's (SAEM) annual meeting starts this week. Instead of my regular posts, I thought I'd try using the Twitter widget to post real-time, first-hand accounts and photos from the conference.

SAEM is a very dynamic and productive conference, where academicians in Emergency Medicine meet to pow-wow about the future of our specialty.

Updated Jun 6, 2010:
The Twitter feed widget is now removed because the SAEM meeting is over. Below is a screenshot of what it looked like.


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.

SAEM Tests (www.saemtests.org)
  • Started in June 2005
  • 24 individual tests covering a spectrum of topics
  • 565 test questions
Currently the tests are used mostly for formative (self-learning) purposes, but the hope is that there can be a standardized, summative "shelf-like" test for clerkships. There is currently a pilot "proctored" test, which is comprised of the most validated test questions.

Sorry for the delay in posting this review (watching closing ceremonies of Olympics)! Check out this article to see how tests are built and validated.


Reference
Senecal EL, Thomas SH. Beeson MS. A Four-Year Perspective of Society for Academic Emergency Medicine Tests: An Online Testing Tool for Medical Students. Acad Emerg Med 2009; 16:S42–S45.

CDEM unites EM community on LCME accreditation standard ED-15


Over the past few years, I have been increasingly aware of how Emergency Medicine, as a specialty, has been under-appreciated by national accreditation organizations, such as the Liaison Committee on Medical Education (LCME). The LCME essentially accredits all U.S. and Canadian medical schools and is sponsored by the AAMC and AMA. Accreditation standards address all aspects of medical student training and periodically gets revised.

This year, at the national AAMC meeting in Boston, there was a call for public comments on the proposed new ED-15 standard:

Standard ED-15
  • The curriculum of the educational program must prepare students to enter any field of graduate medical education and include content that will prepare students to recognize wellness, determinants of health, opportunities for health promotion, and symptoms and signs of disease; develop differential diagnoses and treatment plans; and assist patients in addressing health-related issues involving all organ systems and spanning the life cycle.
Annotation for ED-15
  • It is expected that the curriculum will be guided by the contemporary content from and clinical experiences associated with, among others, the disciplines and related subspecialties that have traditionally been titled family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, public health, and surgery.
Did you notice the glaring omission of EM and EM-related skills from the wording? Meanwhile, EM is growing increasingly more popular amongst students and is rapidly becoming a required clerkship rotation in medical schools. Also, management of undifferentiated patients and many procedures are taught in the ED setting. Alongside the other specialties mentioned, we should be recognized as a "core" specialty within medical schools.


So, yesterday Dr. Dave Wald (Chair of CDEM) released an official letter on behalf of CDEM to the LCME. The proposed wording changes have the backing of the Alliance of Clinical Education (ACE) and the major EM organizations such as AACEM, AAEM, ACEP, CORD, and SAEM. I just posted it onto the CDEM website. If you'd like to read the well-crafted letter, you can download it here.


In brief, here are CDEM's official wording change recommendations (changes in red):

New Proposed Standard ED-15
  • The curriculum of the educational program must prepare students to enter any field of graduate medical education and include content that will prepare students to recognize wellness, determinants of health, and opportunities for health promotion, to recognize and interpret symptoms and signs of disease; to evaluate undifferentiated patients, to develop differential diagnoses and treatment plans; to acquire decision making skills in acute care situations, to formulate evidence-based management for chronic diseases, and to assist patients in addressing health-related issues involving all organ systems and spanning the life cycle.
New Proposed Annotation for ED-15
  • It is expected that the curriculum will be guided by the contemporary content from and clinical experiences associated with, among others, the disciplines and related subspecialties that have traditionally been titled emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, psychiatry, public health, and surgery.
Hopefully the LCME will take our comments into consideration and amend the new ED-15 standard to accommodate our suggestions. It would go a long way towards validating EM as a specialty, as we continue to grow in presence and importance in medical schools.
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