Comparative Effectiveness of an In-Person and a Virtual Basic Emergency Care Instructor Course.

Background: Resource limited settings have an ongoing need for access to quality emergency care. The World Health Organization - International Committee of the Red Cross Basic Emergency Care (BEC) course is one mechanism to address this need. Training of BEC trainers has been challenging due to barriers including cost, travel logistics, scheduling, and more recently, social distancing regulations related to the coronavirus pandemic. Objective: We seek to determine if an online virtual format is an effective way to train additional trainers while overcoming these barriers. Methods: The BEC Training-of-Trainers (ToT) course was adapted to a virtual format and delivered entirely online. Participants were assessed with a multiple choice pre- and post-test and completed a course feedback form upon completion. Results from the virtual course were then compared to the results from an in-person ToT course. Findings: The in-person course pre- and post-tests were completed by 121 participants with a pre-test mean of 87% (range 60-100%) and a post-test mean of 95% (range: 75-100; p < 0.05). Virtual course pre- and post-tests by 27 participants were analyzed with a pre-test mean of 89% (range 75-100%) and a post-test mean of 96% (range: 79-100; p < 0.05). No difference in test improvements between the courses was detected (z = -0.485; p = 0.627). The course feedback was completed by 93 in-person participants and 28 virtual participants. Feedback survey responses were similar for all questions except for course length, with in-person participant responses trending towards the course being too long. Conclusions: A virtual format BEC ToT course is effective, feasible, and acceptable. When compared to an in-person course, no difference was detected in nearly all metrics for the virtual format. Utilizing this format for future courses can assist in scaling both the BEC ToT and, by extension, the BEC course globally, particularly in regions facing barriers to in-person training.

Global emergency medicine: A scoping review of the literature from 2020.

OBJECTIVE: The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. METHODS: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization. RESULTS: The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted OR, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving ECRLS again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques. CONCLUSIONS: The number of studies relevant to global EM identified by our search was very similar to that of last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to DHR. The number of COVID-19-related articles is likely to continue to increase in subsequent years.

COVID-19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration.

To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.

Global Health Training in U.S. Emergency Medicine Residency Programs.

OBJECTIVES: Formal education in global health (GH) and short-term experiences in GH (STEGH) are offered by many emergency medicine (EM) residency programs in the United States. In an increasingly connected world, training in GH and STEGH can provide essential knowledge and practical skills to trainees, particularly at the graduate medical education level. The current core programmatic components and the essential competencies and curricula that support ethical and effective STEGH, however, still vary widely. The authors conducted a survey of the 228 EM residency programs in the United States to describe the current state of GH training and STEGH. METHODS: An online survey was developed in REDCap by a team of GH faculty. In July 2018, programs were invited to participate via individual invitation of program directors from a directory. The programs received two reminders to participate until January 2019. RESULTS: Of the 84 programs that responded, 75% offer STEGH and 39% have longitudinal GH curricula. Within these programs, only 55% have dedicated GH faculty and only 70% have dedicated sites. Both faculty and residents encounter funding and insurance barriers; most notably, only 20% of programs that offer STEGH provide evacuation insurance for their residents. Most residents (95%) engage in clinical work along with teaching and other activities, but 24% of programs do not allow these activities to fulfill any residency requirements. Finally, only 80 and 85% of programs offer preparatory and debriefing activities for residents, respectively. CONCLUSIONS: While the results of this survey show progress relative to prior surveys, there are still barriers to implementing GH curricula and supporting safe, ethical, and effective STEGH, particularly in the form of continued financial and logistic support for faculty and for residents, in U.S. EM training programs.