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1.
Lancet ; 397(10270): 196-197, 2021 01 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1065682
2.
West J Emerg Med ; 22(1): 130-135, 2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: covidwho-1061548

RESUMEN

INTRODUCTION: The COVID-19 pandemic led to a large disruption in the clinical education of medical students, particularly in-person clinical activities. To address the resulting challenges faced by students interested in emergency medicine (EM), we proposed and held a peer-led, online learning course for rising fourth-year medical students. METHODS: A total of 61 medical students participated in an eight-lecture EM course. Students were evaluated through pre- and post-course assessments designed to ascertain perceived comfort with learning objectives and overall course feedback. Pre- and post-lecture assignments were also used to increase student learning. RESULTS: Mean confidence improved in every learning objective after the course. Favored participation methods were three-person call-outs, polling, and using the "chat" function. Resident participation was valued for "real-life" examples and clinical pearls. CONCLUSION: This interactive model for online EM education can be an effective format for dissemination when in-person education may not be available.


Asunto(s)
/prevención & control , Educación a Distancia/métodos , Educación de Pregrado en Medicina/métodos , Medicina de Emergencia/educación , Liderazgo , Modelos Educacionales , Grupo Paritario , Curriculum , Evaluación Educacional , Humanos , Aprendizaje , Ciudad de Nueva York , Autoimagen , Entrenamiento Simulado/métodos , Estudiantes de Medicina/psicología
3.
West J Emerg Med ; 22(1): 136-138, 2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1061429

RESUMEN

The development of clinical reasoning abilities is a core competency of emergency medicine (EM) resident education and has historically been accomplished through case conferences and clinical learning. The advent of the SARS-CoV-2 pandemic has fundamentally changed these traditional learning opportunities by causing a nationwide reliance on virtual education environments and reducing the clinical diversity of cases encountered by EM trainees.We propose an innovative case conference that combines low-fidelity simulation with elements of gamification to foster the development of clinical reasoning skills and increase engagement among trainees during a virtual conference. After a team of residents submits a real clinical case that challenged their clinical reasoning abilities, a different team of residents "plays" through a gamified, simulated version of the case live on a video conference call. The case concludes with a facilitated debriefing led by a simulation-trained faculty, where both the resident teams and live virtual audience discuss the challenges of the case. Participants described how the Challenging Case Conference improved their perceptions of their clinical reasoning skills. Audience members reported increased engagement compared to traditional conferences. Participants also reported an unexpected, destigmatizing effect on the discussion of medical errors produced by this exercise. Residency programs could consider implementing a similar case conference as a component of their conference curriculum.


Asunto(s)
Competencia Clínica , Educación a Distancia/métodos , Medicina de Emergencia/educación , Internado y Residencia/métodos , Entrenamiento Simulado/métodos , Comunicación por Videocoferencia , /prevención & control , California , Curriculum , Humanos
4.
West J Emerg Med ; 22(1): 115-118, 2020 Dec 14.
Artículo en Inglés | MEDLINE | ID: covidwho-1013509

RESUMEN

INTRODUCTION: The coronavirus disease 2019 pandemic forced a rapid transition of in-class residency conferences to online residency conferences; little is known about learners' perceptions of this new didactic environment. Understanding learners' perceptions of virtual classrooms can help inform current and future best practices for online, synchronous, graduate medical education. METHODS: We surveyed emergency medicine and internal medicine residency programs at a large urban academic medical center about their perceptions of synchronous online residency conferences. RESULTS: Residents reported a preference for in-class interactions with peers (85%) and lecturers (80%), with 62% reporting decreased levels of engagement with lecturers during online conferences. Residents reported performing nearly twice as many non-conference-related activities (eg, email, exercise) during online conferences vs in-class conferences. Residents felt that the following methods improved engagement during online conferences: lecturers answering chat questions; small group sessions; and gamification of lectures. CONCLUSION: Synchronous online residency conferences were associated with decreased engagement and attention by learners. Simple methods to increase interactivity may help improve the online classroom experience and cultivate novel teaching environments that better support current learning styles.


Asunto(s)
/prevención & control , Congresos como Asunto , Educación a Distancia/métodos , Medicina de Emergencia/educación , Medicina Interna/educación , Internado y Residencia/métodos , Estudiantes de Medicina/psicología , Chicago , Congresos como Asunto/organización & administración , Educación a Distancia/organización & administración , Femenino , Humanos , Internado y Residencia/organización & administración , Relaciones Interpersonales , Masculino , Percepción , Encuestas y Cuestionarios
6.
J Emerg Manag ; 18(7): 31-35, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-993974

RESUMEN

INTRODUCTION: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic. METHODS: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used. RESULTS: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support. CONCLUSION: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.


Asunto(s)
Medicina de Emergencia , Médicos , Canadá , Cuidados Críticos , Humanos , Pandemias , Estudios Prospectivos , Triaje
10.
Eur J Emerg Med ; 27(3): 174-177, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-963059

RESUMEN

The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Betacoronavirus , Humanos , Control de Infecciones , Pandemias , Aislamiento de Pacientes , Equipo de Protección Personal/provisión & distribución , Triaje
12.
Emerg Med J ; 37(12): 773-777, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-894883

RESUMEN

BACKGROUND: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Hospitales Pediátricos/organización & administración , Neumonía Viral/epidemiología , Adolescente , Betacoronavirus/patogenicidad , Colombia Británica/epidemiología , Niño , Preescolar , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Urgencias Médicas/epidemiología , Medicina de Emergencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Pandemias/prevención & control , Admisión del Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Triaje/organización & administración , Triaje/estadística & datos numéricos
13.
West J Emerg Med ; 21(6): 83-87, 2020 Sep 24.
Artículo en Inglés | MEDLINE | ID: covidwho-869238

RESUMEN

INTRODUCTION: We are currently in the midst of the coronavirus disease 2019 (COVID-19) pandemic. Research into previous infectious disease outbreaks has shown that healthcare workers are at increased risk for burnout during these dire times, with those on the front lines at greatest risk. The purpose of this prospective study was to determine the effect that the COVID-19 pandemic has had on the wellness of emergency physicians (EP). METHODS: A survey was sent to 137 EPs in a multi-hospital network in eastern Pennsylvania. We compared 10 primary and two supplemental questions based on how the physicians had been feeling in the prior 2-3 weeks (COVID-19 period) to the same questions based on how they were feeling in the prior 4-6 months (pre-COVID-19 period). RESULTS: We received 55 responses to the survey (40.1% response rate). The study found that during the pandemic, EPs felt less in control (p-value = 0.001); felt decreased happiness while at work (p-value 0.001); had more trouble falling asleep (p-value = 0.001); had an increased sense of dread when thinking of work needing to be done (p-value = 0.04); felt more stress on days not at work (p-value <0.0001); and were more concerned about their own health (p-value <0.0001) and the health of their families and loved ones (p-value <0.0001). CONCLUSION: This study showed a statistically significant decrease in EP wellness during the COVID-19 pandemic when compared to the pre-pandemic period. We need to be aware of evidence-based recommendations to help mitigate the risks and prevent physician burnout.


Asunto(s)
Agotamiento Profesional/prevención & control , Infecciones por Coronavirus/epidemiología , Salud Laboral , Estrés Laboral/epidemiología , Médicos/psicología , Neumonía Viral/epidemiología , Adulto , Agotamiento Profesional/epidemiología , Infecciones por Coronavirus/prevención & control , Medicina de Emergencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Masculino , Pandemias/prevención & control , Pennsylvania , Neumonía Viral/prevención & control , Estudios Prospectivos , Encuestas y Cuestionarios
14.
BMC Med Educ ; 20(1): 348, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: covidwho-835832

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. METHODS: This was a retrospective study of EM resident physicians' training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods. RESULTS: The mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value = 0.01) and 1.56 to 0.51 in the pediatric ED (p value = 0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. CONCLUSIONS: The COVID-19 pandemic engendered a reduced ED volume and decreased EM residents' clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients' case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Medicina de Emergencia/educación , Internado y Residencia , Pandemias , Neumonía Viral/epidemiología , Adulto , Anciano , Betacoronavirus , Servicio de Urgencia en Hospital/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Taiwán
17.
Emerg Med J ; 37(12): 768-772, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-807792

RESUMEN

BACKGROUND: The COVID-19 pandemic has stretched EDs globally, with many regions in England challenged by the number of COVID-19 presentations. In order to rapidly share learning to inform future practice, we undertook a thematic review of ED operational experience within England during the pandemic thus far. METHODS: A rapid phenomenological approach using semistructured telephone interviews with ED clinical leads from across England was undertaken between 16 and 22 April 2020. Participants were recruited through purposeful sampling with sample size determined by data saturation. Departments from a wide range of geographic distribution and COVID-19 experience were included. Themes were identified and included if they met one of three criteria: demonstrating a consistency of experience between EDs, demonstrating a conflict of approach between emergency departments or encapsulating a unique solution to a common barrier. RESULTS: Seven clinical leads from type 1 EDs were interviewed. Thematic redundancy was achieved by the sixth interview, and one further interview was performed to confirm. Themes emerged in five categories: departmental reconfiguration, clinical pathways, governance and communication, workforce and personal protective equipment. CONCLUSION: This paper summarises learning and innovation from a cross-section of EDs during the first UK wave of the COVID-19 pandemic. Common themes centred around the importance of flexibility when reacting to an ever-changing clinical challenge, clear leadership and robust methods of communication. Additionally, experience in managing winter pressures helped inform operational decisions, and ED staff demonstrated incredible resilience in demanding working conditions. Subsequent surges of COVID-19 infections may occur within a more challenging context with no guarantee that there will be an associated reduction in A&E attendance or cessation of elective activity. Future operational planning must therefore take this into consideration.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Planificación en Desastres , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Neumonía Viral/epidemiología , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Urgencias Médicas/epidemiología , Inglaterra/epidemiología , Humanos , Innovación Organizacional , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Neumonía Viral/virología , Investigación Cualitativa
18.
JMIR Mhealth Uhealth ; 8(9): e23153, 2020 09 24.
Artículo en Inglés | MEDLINE | ID: covidwho-791775

RESUMEN

BACKGROUND: Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. OBJECTIVE: Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. METHODS: We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents' use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. RESULTS: We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19-related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). CONCLUSIONS: Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic.


Asunto(s)
Ansiedad/epidemiología , Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Pandemias , Neumonía Viral/psicología , Red Social , Adulto , Anestesiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos , Estudios Transversales , Medicina de Emergencia , Femenino , Francia/epidemiología , Personal de Salud/estadística & datos numéricos , Humanos , Internet , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estudios Prospectivos , Encuestas y Cuestionarios
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